Association of diet quality with the risk of Sarcopenia based on the Chinese diet balance index 2016: a cross-sectional study among Chinese adults in Henan Province.

BACKGROUND: Sarcopenia can lead to a series of unfavourable health outcomes. Diet is an important factor influencing sarcopenia. In this study, we aimed to evaluate the association of sarcopenia with diet quality assessed by the Chinese Diet Balance Index 2016 (DBI-16). METHODS: A cross-sectional study was conducted to collect information on nutrition and health in Henan Province, China, and a total of 644 individuals were studied. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria updated in 2019. Diet quality was assessed by using the Chinese Diet Balance Index 2016 (DBI-16), which includes three indicators: the lower bound score (LBS), higher bound score (HBS) and diet quality distance (DQD). Binary logistic regression analysis was used to estimate the risk of sarcopenia associated with diet quality. RESULTS: A total of 49 of the 644 participants were diagnosed with sarcopenia. Excessive intake (score > 0) of cereals, meat, eggs and salt, inadequate intake (score < 0) of vegetables, fruits, dairy products, soybeans and low diet variety were commonly seen in both groups of participants. The participants with sarcopenia had a more serious inadequate intake of fruit than those without sarcopenia (p < 0.05). The overall LBS, HBS and DQD in both groups were in the interval of low-level problems. Compared with participants with a suitable LBS, those with an unsuitable LBS were more likely to have a low gait speed (OR: 2.58; 95%CI: 1.13-7.04) after multiple adjustments. However, the other two DBI-16 indicators, the HBS and DQD, were not associated with sarcopenia or its related diagnostic variables. CONCLUSION: Unfavourable diet quality, mainly referring to inadequate dietary intake in this study, may be a risk factor for low gait speed.

Suboptimal dietary quality is associated with mental symptoms among adults aged 40 years and over in China: A population-based cross-sectional study.

BACKGROUND: The previous studies an association between dietary patterns and psychiatric symptoms. However, few studies have examined the association of quality of dietary patterns and anxiety, depressive symptoms in the Chinese population. METHODS: Between 2017 and 2019, a population-based, cross-sectional survey was carried out in China. Uniformed questionnaires collected the demographic characteristics and food data. The dietary quality of the adults was evaluated using the revised Diet Balance Index 2016 (DBI-16). We measured anxiety and depression symptoms using the the Generalized Anxiety Disorder (GAD)-7 and Patient Health Questionnaire (PHQ)-9. RESULTS: A total of 73,737 participants were recruited during the survey period. 17.6 % and 13.7 % of residents suffer from anxiety and depression symptoms, respectively. The DBI-16 indicates that participants with anxiety or depression symptoms had higher scores of low bound score (LBS, refers to inadequate food intake) and dietary quality distance (DQD, refers to unbalanced food intake) than those without anxiety or depression. The logistic regression models showed that high levels of LBS and DQD problems were more strongly associated with anxiety (LBS:OR = 1.20, DQD:OR = 1.30) and depressive symptoms (LBS:OR = 1.21, DQD:OR = 1.44). On the contrary, higher bound score (HBS, refers to excessive food intake) was significantly negatively correlated with symptoms of anxiety and depression. Moreover, each increase in the food group was associated with 4 % lower odds of anxiety and 6 % lower odds of depression symptoms. LIMITATIONS: Cross-sectional design and self-reporting of psychological symptoms and dietary information limit the generalizability of the results. CONCLUSION: The dietary quality of adults aged 40 years and over in China is suboptimal, with excessive and inadequate food intake simultaneously. Dietary imbalance, and low dietary diversity may be related to anxiety and depressive symptoms.

Association of diet quality during pregnancy with maternal glucose metabolism in Chinese women.

Overall diet quality during pregnancy has played an important role on maternal glucose metabolism. However, evidence based on the adherence to the dietary guideline is limited, especially for Asian populations. We aimed to examine the association between adherence to the Chinese dietary guideline measured by the Diet Balance Index for Pregnancy (DBI-P) and maternal glucose metabolism, including gestational diabetes mellitus (GDM) status, fasting and 2-h plasma glucose. Data were obtained from the baseline survey of the Yuexiu birth cohort. We recruited 942 pregnant women at 20-28 weeks of gestation in 2017-2018. Dietary intakes during the past month were collected using a validated semi-quantitative FFQ. The scores of DBI-P were calculated to assess dietary quality. Lower absolute values of the scores indicate higher adherence to the Chinese dietary guidelines. All participants underwent a 75 g of oral glucose tolerance test (OGTT). Multiple linear regression and logistic regression were conducted. The Benjamini-Hochberg method was used to adjust multiple comparisons across DBI-P food components. The value of high bound score indicator, reflecting excessive total food intake, was positively associated with OGTT-2h glucose levels (ß = 0·037, P = 0·029). After adjustment for multiple comparisons, the score of animal food intake was positively associated with OGTT-2 h glucose levels (ß = 0·045, P = 0·045) and risk of GDM (OR = 1·105, P = 0·030). In conclusion, excessive total food intake was associated with higher postprandial glucose in pregnant women. Lower compliance with the dietary guideline for animal food was associated with both higher postprandial glucose and increased risk of GDM during pregnancy.

Association between dietary quality and bone mass among middle-aged and elderly people in Gansu Province / 西安交通大学学报(医学版)

【Objective】 To evaluate the dietary quality with the dietary balance index (DBI_16) and the association between dietary quality and bone mass among middle-aged and elderly people in Gansu Province so as to provide evidence for improving dietary quality and bone health status of Gansu population. 【Methods】 Based on the information of the type and quantity of food intake and the bone mass of middle-aged and elderly people aged 35 years and above collected by the Gansu Project in the Regional Ethnic Cohort Study in Northwest China, DBI_16 was used to evaluate the intake level of cereals, vegetables, fruits, milk, beans, fish and shrimp, eggs and other foods, and the degree of inadequate, excessive and unbalanced dietary intake of the participants. Multiple linear regression was used to evaluate the associations of three component indexes of DBI_16, high bound score (DBI_HBS), low bound score (DBI_LBS), diet quality distance (DBI_DQD), and seven single indexes of DBI_16 with bone mass. 【Results】 Analyses of the dietary and bone mass data of 11,840 participants showed that 44.8% of participants consumed excessive amounts of cereals compared to the dietary recommendation. 96.3%, 90.6%, 90.1%, 71.9%, 95.1% and 60.3% of participants’ intake of vegetables, fruits, milk, soybeans, fish and shrimp, and eggs, respectively, were inadequate. 47.7% participants consumed less than 10 types of food. 2.3% participants’ DBI_LBS levels were appropriate. 54.7% participants’ DBI_HBS levels were appropriate. Only 1.2% participants’ DBI_DQD reached a balanced level. The bone mass level in the study population was (2.5±0.6) kg [(2.8±0.5) kg for men and (2.3±0.5) kg for women]. After adjusting for sociodemographic characteristics, lifestyle, total dietary energy intake and body mass index, DBI_LBS and DBI_DQD were negatively associated with bone mass [β and 95% CI was -0.002 01 (-0.003 62--0.000 40) and -0.001 76 (-0.003 09--0.000 43), respectively]. 【Conclusion】 Dietary intake imbalance is common among middle-aged and elderly people in Gansu Province, and the more severe the dietary intake imbalance, the lower the bone mass level.

Association between early childhood caries and diet quality among Chinese children aged 2-5 years.

Background: Early childhood caries (ECC) is a major oral problem affecting the health and wellbeing of children worldwide. Diet quality is a better predictor of ECC risk than single foods or specific nutrients. The purposes of this study were to assess the associations between ECC and diet quality among 2- to 5-year-old Chinese children. Methods: A total of 150 eligible children were included in this study. The decayed, missing, or filled surface (dmfs) score was recorded for each child by dental examination. All participants were divided into three groups based on their age and dmfs score [the caries-free group, the ECC group, and the severe early childhood caries (S-ECC) group]. Parents were invited to complete a questionnaire on the general characteristics and oral health behaviors of the participants. The information of 24-h dietary intake from each child was captured via a mobile APP. The Chinese diet balance index for preschool children (DBI_C) indicators score, high bound score (HBS), low bound score (LBS), and diet quality distance (DQD) score were calculated to assess the diet quality of study subjects. The associations of ECC with HBS, LBS, DQD score, and DBI_C indicators score were analyzed by Mann-Whitney U test and multivariable logistic regression analysis. Results: In this study, 21, 31, and 98 children were diagnosed with caries-free, ECC, and S-ECC, respectively. Statistical analysis revealed that the risk of ECC and S-ECC were significantly increased with the DQD score (OR = 1.283 and 1.287, respectively), but both were not associated with HBS and LBS (P > 0.05). In the meantime, the risk of ECC and S-ECC were significantly increased with the Grains score (OR = 1.623 and 1.777, respectively), and significantly decreased with the Food diversity score (OR = 0.271 and 0.315, respectively). Moreover, the risk of S-ECC also significantly decreased with the Vegetables score (OR = 0.137). Conclusion: Both ECC and S-ECC were associated with a high degree of dietary imbalance and grains intake as well as a low degree of food diversity among Chinese children aged 2-5 years. In addition, S-ECC was also associated with a low degree of vegetable intake.

Long-Term Diet Quality and Risk of Diabetes in a National Survey of Chinese Adults.

There is little evidence involving the association between diet quality and the risk of diabetes among the Asian populations, especially from the long-term prospective cohort studies in China. This study evaluated the long-term diet quality of Chinese adults by the Chinese diet balance index 2016 (DBI-16) and firstly explored its role in diabetes prevention. A total of 9394 participants from the China health and nutrition survey (2004-2015) prospective cohort were included. Dietary information was selected by three consecutive 24-h dietary recalls, combined with a household food inventory and further calculated as the scores of the DBI-16 components and indicators. Three major indicators, the low bound score (LBS), the high bound score (HBS) and the diet quality distance (DQD), were divided into four level groups, according to the total scores, respectively, including Level 1 (scores below 20%), Level 2 (20-40% of scores), Level 3 (40-60% of scores) and Level 4 (scores above 60%). Diabetes cases were identified through a questionnaire or by testing the overnight fasting blood samples. Cox's proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs, while restricted cubic splines (RCS) were applied to explore the potentially non-linear relationships. During a median follow-up of 6.0 years (61,979 persons-years), 657 participants developed diabetes. The LBS and DQD scores were positively associated with diabetes risks, whereas no significant association of the HBS scores with diabetes risks was observed. Compared with those on the lowest level, the adjusted HRs (95%) across the increased levels of diet quality were 2.43 (1.36, 4.37), 3.05 (1.69, 5.53) and 4.90 (2.46, 9.78) for the LBS; 1.06 (0.74, 1.51), 1.30 (0.99, 1.88) and 0.99 (0.39, 2.55) for the HBS; 1.28 (1.01, 1.61) and 2.10 (1.57, 2.82) for the DQD after pooling the participants on Level 1 and 2 as the reference group, due to the few who developed diabetics on Level 1 of the DQD. No significantly non-linear shape was observed for all three indicators. Our findings indicated a significant inverse association between the long-term diet quality assessed by the DBI-16 and diabetes risks, providing evidence for the positive role of healthy diets in diabetes prevention in Asia.

The Role of Dietary Patterns and Dietary Quality on Body Composition of Adolescents in Chinese College.

There is limited evidence regarding the effects of dietary pattern and dietary quality on the risk of unhealthy weight status and related body composition in Chinese adolescence. In particular, studies using bioelectrical impedance analyzer (BIA) in these subjects are rare. The aim of this study was to evaluate the role of diet in body composition, to find a healthy dietary pattern for Chinese youth, and to promote the application of BIA among this population. A total of 498 participants aged from 18 to 22 years old were included. Dietary patterns were identified by principal components analysis. Energy-adjusted dietary inflammatory index (DII) and diet balance index (DBI) were calculated based on semi-quantitative food frequency questionnaire. Multivariate linear regression and logistic regression analysis were used to examine the relationship of dietary patterns, dietary quality with body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and the effect of dietary factors on BMI levels. The majority of participants with overweight and obesity had abdominal obesity, and there was 3.7% abdominal obesity in normal BMI individuals. Four dietary patterns were detected in the subjects. The pattern with the higher energy intake, which was close to the Western diet, was positively correlated with BMI (ß = 0.326, p = 0.018) and FMI (ß = 0.201, p = 0.043), while being negatively correlated with FFMI (ß = −0.183, p = 0.021). Individuals who followed the pattern similar to the Mediterranean diet had a higher basal metabolic rate (BMR), and the highest fat free mass, soft lean mass, and skeletal muscle mass (p < 0.05) but the lowest FMI, visceral fat area (VFA), waist−hip ratio, and FMI/FFMI ratio (p < 0.05). Higher energy-adjusted DII was associated with high BMI. Higher bound score (HBS) (ß = −0.018, p = 0.010) and diet quality distance (DQD) (ß = −0.012, p = 0.015) were both negatively correlated with FFMI. In conclusion, fat or muscle indexes, such as BMR, FMI, and FFMI, had an important role in predicting overweight and obesity, which suggested the importance of applying BIA among Chinese college students. Students who followed healthful dietary patterns or the high-quality diet that is similar to the Mediterranean diet but not close to the Western diet were more likely to have a healthy BMI and normal body composition.

Association between dietary quality and executive functions in school-aged children with autism spectrum disorder.

Background: It is well known that children with autism spectrum disorder (ASD) had executive functions deficit. However, it is still unclear whether the poor dietary quality is related to the impairment of executive functions. The current study aimed to explore the association between dietary quality and executive functions in children with ASD. Methods: A total of 106 children with ASD (7.7 ± 1.3 years) and 207 typically developing (TD) children (7.8 ± 1.3 years) were enrolled from Guangzhou, China. The Chinese version of Behavior Rating Scale of Executive function (BRIEF), the working memory subscales of the Chinese version of Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), and the Stroop Color-Word Test (SCWT) were used to measure the participant's executive functions. The food frequency questionnaire (FFQ) was used to collect the dietary intake information, and the Chinese Diet Balance Index (DBI_16) was used to evaluate the dietary quality. Generalized linear models were used to estimate the association between dietary quality and executive functions. Results: In children with ASD, Low Bound Score (LBS) was positively correlated with the working memory subscale score of BRIEF (ß = 0.23, 95% CI: 0.02-0.44, P < 0.05), while High Bound Score (HBS) and LBS were positively correlated with the organizable subscale score of BRIEF (ß = 0.44, 95% CI: 0.11-0.77, P < 0.01; ß = 0.19, 95% CI: 0.01-0.37, P < 0.05). Compared to TD children, children with ASD had a higher proportion of moderate and high levels of insufficient dietary intake (moderate level, 37.7% vs. 23.2%, high level, 4.7% vs. 1.4%) and moderate level of unbalanced dietary intake (36.8% vs.21.3%), higher scores on all subscales of BRIEF (P < 0.01), and lower score on the working memory (81.3 ± 32.3 vs. 104.6 ± 12.5, P < 0.01), while there was no difference on the SCWT. Conclusion: Poor dietary quality was associated with the impairment of working memory and organizational capacity in children with ASD. This study emphasized the importance of dietary quality in executive functions among children with ASD, and attention should be paid to improving their dietary quality.

[Association between the diet balance index-based dietary quality and cognitive function among Zhejiang population aged 40 years and older].

OBJECTIVE: To evaluation the dietary quality of Zhejiang population aged 40 years and older using the Dietary Balance Index(DBI) and to analyze the association between dietary quality and cognitive function. METHODS: The dietary information was collected with the help of questionnaire survey, a 3-day dietary recall and household condiment weighing method from Zhejiang participants of the 2018 wave of the China Health and Nutrition Survey aged 40 years and older, and the food and energy intakes were calculated. The cognitive function was assessed by the Mini Mental Status Examination. Dietary quality was evaluated using the DBI method. A multivariate Logistic regression model was used to examine the association between dietary quality and the risk of cognitive impairment. RESULTS: Among 640 participants aged 40 years and older, 14.2% had cognitive impairment. Univariate analysis showed that those with cognitive impairment had higher cereal(P=0.001), particularly, higher rice and products intake(P<0.001), as well as higher egg intake(P=0.008) than those with normal cognitive function; while the intake of soybean and its product(P=0.025) was lower. Those with cognitive impairment had higher DBI score of cereal(P=0.006) and high bound score(HBS)(P=0.028)than those with normal cognitive function. After adjustment for possible confounding factors, Logistic regression showed that moderated and severe over-consumption was positively associated with cognitive impairment(OR=2.486, 95% CI 1.130-5.470, P=0.024). CONCLUSION: Over-consumption may increase the risk of cognitive impairment among aged Zhejiang population, and should be used to prevent or reduce cognitive decline by improving the quality of the diet through a reasonable dietary mix.

Unfavorable Dietary Quality Contributes to Elevated Risk of Ischemic Stroke among Residents in Southwest China: Based on the Chinese Diet Balance Index 2016 (DBI-16).

Background: Little is known about the effects of dietary quality on the risk of ischemic stroke among Southwest Chinese, and evidence from prospective studies is needed. We aimed to evaluate the associations of ischemic stroke with dietary quality assessed by the Chinese Diet Balance Index 2016 (DBI-2016). Methods: The Guizhou Population Health Cohort Study (GPHCS) recruited 9280 residents aged 18 to 95 years from 12 areas in Guizhou Province, Southwest China. Baseline investigations, including information collections of diet and demographic characteristics, and anthropometric measurements were performed from 2010 to 2012. Dietary quality was assessed by using DBI-2016. The primary outcome was incident ischemic stroke diagnosed according to the International Classification of Diseases 10th revision (ICD-10) until December 2020. Data analyzed in the current study was from 7841 participants with complete information of diet assessments and ischemic stroke certification. Cox proportional hazards models were used to estimate the risk of ischemic stroke associated with dietary quality. Results: During a median follow-up of 6.63 years (range 1.11 to 9.53 years), 142 participants were diagnosed with ischemic stroke. Participants with ischemic stroke had a more excessive intake of cooking oils, alcoholic beverages, and salt, and had more inadequacy in meats than those without ischemic stroke. (p < 0.05). Compared with participants in the lowest quartile (Q1), those in the highest quartile (Q4) of the higher bound score (HBS) and of the dietary quality distance (DQD) had an elevated risk for ischemic stroke, with the corresponding hazard ratios (HRs) of 3.31 (95%CI: 1.57−6.97) and 2.26 (95%CI: 1.28−4.00), respectively, after adjustment for age, ethnic group, education level, marriage status, smoking and waist circumference, and the medical history of diabetes and hypertension at baseline. In addition, excessive intake levels (score 1−6) of cooking oils, excessive intake levels (score 1−6) of salt, and inadequate intake levels (score −12 to −7) of dietary variety were positively associated with an increased risk for ischemic stroke, with the multiple HRs of 3.00 (95%CI: 1.77−5.07), 2.03 (95%CI: 1.33−3.10) and 5.40 (95%CI: 1.70−17.20), respectively. Conclusions: Our results suggest that unfavorable dietary quality, including overall excessive consumption, excessive intake of cooking oils and salt, or under adequate dietary diversity, may increase the risk for ischemic stroke.

Maternal diet quality during pregnancy and its influence on low birth weight and small for gestational age: a birth cohort in Beijing, China.

This study aimed to describe diet quality of pregnant women and explore the association between maternal diet and the prevalence of low birth weight (LBW) and small for gestational age (SGA). A total of 3856 participants from a birth cohort in Beijing, China, were recruited between June 2018 and February 2019. Maternal diet in the first and second trimesters was assessed by the Chinese diet balance index for pregnancy (DBI-P), using data collected by the inconsecutive 2-d 24-h dietary recalls. Logistic regressions were performed to explore the independent effects of DBI-P components on LBW and SGA. The prevalence of LBW and SGA was 3·8% and 6·0%, respectively. Dietary intakes of the participants were imbalanced. The proportions of participants having insufficient intake of vegetables (87·3% and 86·6%), dairy product (95·9% and 96·7%) and aquatic foods (80·5% and 85·3%) were high in both trimesters. The insufficiency of fruit intake was more severe in the second (85·2%) than that in the first trimester (22·5%) (P < 0·05). After adjusting for potential confounders, the intake of fruits and dairy in the second trimester was negatively associated with the risk of LBW (OR = 0·850, 95% CI: 0·723, 0·999) and SGA (OR = 0·885, 95% CI: 0·787, 0.996), respectively. Sufficient consumption of fruits and dairy products in pregnancy may be suggested in order to prevent LBW and SGA.

Evaluation of diet quality among pregnant women in Shaanxi Province by Diet Balance Index for Pregnancy / 西安交通大学学报(医学版)

【Objective】 To evaluate the diet quality of pregnant women in Shaanxi Province by Diet Balance Index for Pregnancy (DBI_P) and investigate the influencing factors. 【Methods】 By using a multi-stage stratified random sampling method, 7375 pregnant women in 30 districts (counties) of Shaanxi Province were recruited. A structured questionnaire was adopted to collect general information in pregnancy, and a semi-quantitative food frequency questionnaire was used to obtain dietary information in pregnancy. DBI_ P was used to evaluate the diet quality during pregnancy, and the factors influencing diet quality were assessed by multiple linear regression. 【Results】 More than 50% pregnant women had inadequate intakes of dairy products, fish and shrimp, meat and poultry, vegetables, eggs, fruits and diet variety. More than 69% pregnant women had excessive intakes of cooking oil, cereals and salt. The average values of high bound score, low bound score, and diet quality distance were 12.9, 19.5, and 32.5, respectively. The proportions of medium inadequate, excessive, and imbalance of dietary intakes were 20.3%, 22.55%, and 40.8%, respectively. DBI_LBS during pregnancy was negatively correlated with childbearing age, education level, family per capita annual income, antenatal examination frequency and folic acid supplementation, but positively correlated with living in southern and northern Shaanxi, residing in rural areas, being farmers, and drinking alcohol. DBI_HBS during pregnancy was negatively correlated with living in southern and northern Shaanxi, but positively correlated with active/passive smoking and drinking strong tea. DBI_DQD during pregnancy was negatively correlated with education level, family per capita annual income, antenatal examination frequency and folic acid supplementation, but positively correlated with living in southern Shaanxi, residing in rural areas, being farmers, parity, active/passive smoking, and drinking strong tea and coffee. 【Conclusion】 The dietary intake of pregnant women in Shaanxi Province was insufficient and unbalanced, and the dietary quality was affected by sociodemographic and life behavior factors during pregnancy. Nutritional intervention measures should be targeted.

Evaluation on the dietary quality of patients with Type 2 diabetes mellitus in the community by adjusted Chinese diet balance index / 中华健康管理学杂志

Objective:To evaluate the diet quality of patients with Type 2 diabetes mellitus (T2DM) in the community with the Chinese Dietary Balance Index (DBI-16) and to provide a scientific basis for nutrition education.Methods:A random cluster sampling method was adopted to conduct a questionnaire survey of 332 T2DM patients in a community of Bengbu City to obtain demographic sociology and dietary intake information. DBI-16 was used to score and evaluate dietary structure and diet quality.Results:There are low-level under-intake (low bound score =14.0) and excessive intake (high bound score =14.0) in the diet of this population. The degree of excessive intake of men (high bound score =15.0) was higher than that of women (high bound score=13.0) ( Z=-3.12, P<0.01), and the degree of insufficient diet (low bound score =13.0) was lower than that of women (low bound score=15.5)( Z=-2.05, P<0.05). Those with monthly income<1 000 (low bound score =15.5) patients ( χ2 =6.34, P<0.05) and disease course>10 years (low bound score =16.0) had the highest degree of insufficient dietary intake ( χ2 =9.40, P<0.01). Those who did not participate in community health education lectures had significantly higher dietary intake (low bound score =15.0) and imbalance (diet quality distance= 29.0) than those who participated in community health education (low bound score=13.0)(diet quality distance=27.0)( Z=-2.46, P<0.01). According to the score distribution of the DBI-16 index, 73.6% of patients had a severe over-intake of cereals, and only 27.4% and 27.7% had intake of vegetables, fruits, and milk beans that reached the recommended intake. The dietary pattern mainly reflects the existence of a certain degree of excessive dietary intake pattern D. Conclusion:The dietary quality of T2DM patients in Bengbu′s community is in a state of low imbalance. Insufficient and excessive dietary intake coexist and urgently need to be improved.

Perceived social support and diet quality among ethnic minority groups in Yunnan Province, Southwestern China: a cross-sectional study.

BACKGROUND: Social support is an important health determinant and may affect dietary behaviors. The purpose of this study was to examine the relations between perceived social support and the Chinese Diet Balance Index-16 (DBI-16) among ethnic minority groups in Southwest China. METHODS: This cross-sectional study was conducted between May 2019 and August 2020 among six ethnic minority groups native to Yunnan Province (n = 3564). Perceived social support from family, friends and significant others were measured with the Multi-dimensional Scale of Perceived Social Support (MSPSS). Dietary data were obtained using a 100-item Food Frequency Questionnaire (FFQ) and a lifestyle questionnaire. Lower Bound Score (LBS), Higher Bound Score (HBS) and Diet Quality Distance (DQD) which represent inadequate, excessive and unbalanced food intake respectively were calculated to measure the compliance with the recommendations of the Dietary Guidelines for Chinese 2016. RESULTS: One thousand four hundred ninety-six men and two thousand sixty-eight women were included. 51.2% of the subjects had moderate or high levels of inadequate intake; 21.3% had moderate or high levels of excessive intake; and 74.0% had moderate or high levels of unbalanced dietary intake. With potential confounders adjusted, support from family was negatively associated with inadequate intake, while support from friends was positively associated with inadequate and excessive intake. No significant associations were found between perceived social support from significant others and diet quality indicators. CONCLUSIONS: An unbalanced diet is common among adults of the ethnic minority groups in Yunnan Province, Southwest China. Social support should be taken into account in designing nutrition interventions rather than focusing solely on individuals.

Association Between Dietary Quality and Postpartum Depression in Lactating Women: A Cross-Sectional Survey in Urban China.

Background: Evidence on the effects of dietary quality on the risk of postpartum depression in the Chinese population is limited. This study aimed to examine the association between dietary quality and postpartum depression in Chinses lactating women. Methods: A total of 939 participants from 10 cities were included in this analysis. A one-time 24-h dietary recall was used to obtain the data on food consumption and dietary quality was assessed based on Diet Balance Index. The Edinburgh postnatal depression scale was considered at a cutoff point of 10 to detect postpartum depression. Poisson regression models were used to explore the association of dietary quality with postpartum depression. Results: Depressed women tended to have a more inadequate intake of vegetables and have more insufficient food variety. The median (25th, 75th) of the overall high bound score (HBS), low bound score (LBS), and diet quality distance (DQD) was 9 (5, 14), 30 (25, 37), and 40 (34, 47), respectively. Compared with subjects with the lowest quartile of LBS, those with the highest quartile of LBS had a higher risk of postpartum depression [adjusted prevalence ratio (aPR), 1.08; 95% confidence interval (95% CI), 1.01, 1.15; P for trend, 0.043]. We also observed a significant association between DQD and postpartum depression (Q4 vs. Q1: aPR, 1.07; 95% CI: 1.00, 1.14; P for trend, 0.036). Conclusion: Poor dietary quality was associated with postpartum depression in Chinese lactating women.

Associations between Adherence to Four A Priori Dietary Indexes and Cardiometabolic Risk Factors among Hyperlipidemic Patients.

Little is known about which currently available a priori dietary indexes provide best guidance for reducing cardiometabolic risk factors (CMRF) among hyperlipidemic patients. This study was designed to compare the associations between four a priori dietary indexes, including Diet Balance Index (DBI-16), Chinese Healthy Eating Index (CHEI), Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) and CMRF among hyperlipidemic patients. A total of 269 participants were enrolled into the cross-sectional study. DBI-16, CHEI, MDS, and DASH scores were calculated using established methods. CMRF was measured using standard methods. DBI-total scores (DBI-TS) were inversely associated with triglyceride concentrations and TC:HDL-C ratio, and positively associated with HDL-C and ApoA1 concentrations (all p < 0.05), while the results for DBI-low bound scores (DBI-LBS) were opposite. DBI-high bound scores (DBI-HBS) and DASH scores were positively and inversely associated with glucose concentrations, respectively (both p < 0.05). Higher diet quality distance (DQD) was positively associated with higher TC, LDL-C and ApoB concentrations, and TC:HDL-C and LDL-C:HDL-C ratios, and lower HDL-C and ApoA1 concentrations and ApoA1:ApoB ratio (all p < 0.05). CHEI scores were inversely associated with triglyceride concentrations (p = 0.036). None of the dietary indexes was associated with blood pressures. DBI-16 provided most comprehensive evaluations of the overall diet quality and balance for optimizing cardiometabolic health among hyperlipidemic individuals.

Evaluation of the dietary quality of De'ang nationality residents over 18 years old in Yunnan by Diet Balance Index DBI_16 / 公共卫生与预防医学

Objective To evaluate the dietary quality of De'ang nationality residents over 18 years old in Yunnan Provinceusing the new adjusted Diet Balance Index (DBI_16), and to provide scientific basis for improving the nutritional status of De'ang residents and formulating health promotion strategies. Methods A food-frequency questionnaire was used to investigate the diet of De'ang residents, and the new adjusted dietary balance index (DBI_16) was used to evaluate the dietary quality. Results The dietary quality of De'ang nationality residents over 18 years old in Yunnan Province was in a moderately imbalanced state (DQD=42), and the main problem was insufficient dietary intake (LBS = 26). The dietary imbalance among men, 65-79 years old and low-income people was serious. The intake of milk, vegetables, fruits and aquatic products was the most insufficient and people who met the recommended intake levels of these foods were 2%, 34.7%, 31.8%, and 36%, respectively. Meanwhile, there existed the problem of excessive intakes among people studied in the present investigation. Pople who consumed more than recommended amount of Cereal food, livestock and poultry meat, and edible oil accounted for 76.9%, 60.4% and 63.5%, respectively. Conclusion The dietary structure of De'ang residents over 18 years old in Yunnan Province is unreasonable. The problems of both insufficient and excessive dietary intakes exist. Education on balance diet should be conducted to improve nutrition and health status of De'ang nationality residents.

[Evaluation of dietary quality of Chinese preschool children based on Chinese diet balance index for preschool children].

Objective: To establish Chinese diet balance index for preschool children（DBI_C), and evaluate the dietary quality of Chinese preschool children. Methods: DBI_C was established according to the methods establishing DBI_16 and the recommended intake of different kinds of food for preschool children. Three scoring methods [low bound score （LBS), high bound score （HBS), diet quality distance （DQD)] were used to evaluate the dietary quality of preschool children selected from the 2010-2012 China National Nutrition and Health Surveillance. Scores [P50（P25, P75)] were compared to reflect the diet quality of preschool children in different regions. Results: DBI_C scores for cereals of preschool children from big city, middle and small city, normal rural area, and poor rural area were 0.0 （-2.0, 6.0), 0.0 （0.0, 6.0), 4.0 （0.0, 10.0), and 10.0 （2.0, 12.0), respectively （P<0.001), indicating that the intakes of cereals of preschool children were adequate. Scores for animal food of preschool children from four types of location were 0.0 （-2.0, 2.0), 0.0 （-6.0, 2.0), -4.0 （-6.0, 0.0), and -6.0 （-8.0,-2.0), respectively （P<0.001), indicating that the intakes of animal food of rural preschool children were inadequate. Scores for vegetable and fruit, milk and soybean were both less than 0 （P<0.001), indicating that the intakes of these food were insufficient in both urban and rural area. Scores of LBS, HBS and DQD were 24.0 （18.0, 30.0), 8.0 （3.0, 13.0) and 33.0（26.0, 39.0). Children without diet insufficient problem in four type of location accounted for 30.8%, 7.8%, 4.3% and 1.1%, respectively （P<0.001). Children without diet excessive problem accounted for 54.0%, 57.3%, 52.9% and 32.6%, respectively （P<0.001). Children without diet imbalance problem were 10.6%, 1.1%, 1.3% and 0.3%, respectively （P<0.001). Conclusion: Diet quality of urban preschool children is better than that of rural preschool children. Dietary imbalance is the main problem among Chinese preschool children.

Are the Chinese Moving toward a Healthy Diet? Evidence from Macro Data from 1961 to 2017.

The change in diet structure is one of the critical features of social transformation, and diet structure is directly related to human health. In China, with rapid economic development, changes in the diet structure of the population have begun and are proceeding at a fairly rapid rate. In order to reveal how the Chinese diet is approaching or deviating from the nutritional goal, a novel index, NDBI (National Dietary Balance Index), is developed in this study to investigate the Chinese diet from 1961 to 2017 at a national level. The results show that the Chinese diet has transitioned from the under-intake stage to the over-intake stage. Before the 1980s, Chinese people ate all foods inadequately except staple foods; after the 1980s, the issue of under-intake began to fade, and the intake of meats even became excessive. The intake of staple foods is always excessive during this period. Currently, the Chinese diet is still unhealthy because of the inadequate intake of dairy products and the excessive intake of staple foods and meats. By evaluating diet structure on a national level, this study can help people to better understand how the Chinese diet deviated from the nutritional goal and provides information for policymakers intervening in China's food consumption.

Diet quality is associated with reduced risk of hypertension among Inner Mongolia adults in northern China.

OBJECTIVE: The present study investigated the association between dietary patterns and hypertension applying the Chinese Dietary Balance Index-07 (DBI-07). DESIGN: A cross-sectional study on adult nutrition and chronic disease in Inner Mongolia. Dietary data were collected using 24 h recall over three consecutive days and weighing method. Dietary patterns were identified using principal components analysis. Generalized linear models and multivariate logistic regression models were used to examine the associations between DBI-07 and dietary patterns, and between dietary patterns and hypertension. SETTING: Inner Mongolia (n 1861). PARTICIPANTS: A representative sample of adults aged ≥18 years in Inner Mongolia. RESULTS: Four major dietary patterns were identified: 'high protein', 'traditional northern', 'modern' and 'condiments'. Generalized linear models showed higher factor scores in the 'high protein' pattern were associated with lower DBI-07 (ßLBS = -1·993, ßHBS = -0·206, ßDQD = -2·199; all P < 0·001); the opposite in the 'condiments' pattern (ßLBS = 0·967, ßHBS = 0·751, ßDQD = 1·718; all P < 0·001). OR for hypertension in the highest quartile of the 'high protein' pattern compared with the lowest was 0·374 (95 % CI 0·244, 0·573; Ptrend < 0·001) in males. OR for hypertension in the 'condiments' pattern was 1·663 (95 % CI 1·113, 2·483; Ptrend < 0·001) in males, 1·788 (95 % CI 1·155, 2·766; Ptrend < 0·001) in females. CONCLUSIONS: Our findings suggested a higher-quality dietary pattern evaluated by DBI-07 was related to decreased risk for hypertension, whereas a lower-quality dietary pattern was related to increased risk for hypertension in Inner Mongolia.