Dietary calcium intake at breakfast is associated with a lower risk of cognitive impairment than at dinner in Chinese adults: the CHNS cohort study.

BACKGROUND AND OBJECTIVES: If the proportion of calcium intake over a whole day is related to the risk of cognitive impairment in adults is still largely unknown. This research aimed to examine the relation of dietary calcium intake at dinner versus breakfast with the risk of cognitive impairment by using data from the China Health and Nutrition Survey (CHNS). METHODS AND STUDY DESIGN: A total of 2,099 participants (including 668 cognitive impairment) in the CHNS (1997-2006) were included. The participants were categorized into 5 groups in accordance with the ratio of dietary calcium intake at dinner and breakfast (Δ = dinner/breakfast). After adjustment was conducted for a series of confounding factors, Cox hazard regression modelling was performed to discuss the relation of Δ with cognitive impairment. Dietary substitution models were used to explore the changes in cognitive impairment risk when a 5% dietary calcium intake at dinner was replaced with dietary calcium intake at breakfast. RESULTS: Participants in the highest distribution of Δ showed a greater susceptibility to cognitive impairment than those in the lowest quintile, with an adjusted hazard ratio of cognitive impairment of 1.38 (95% CI: 1.08-1.76). When maintaining total calcium intake, substituting 5% of dietary calcium intake at dinner with calcium intake at breakfast was related to an 8% decrease in the risk of cognitive impairment. CONCLUSIONS: Higher dietary calcium intake at dinner was associated with an increased risk of cognitive impairment, emphasizing the importance of appropriately distributing dietary calcium intake between breakfast and dinner.

Seafood intake in childhood/adolescence and the risk of obesity: results from a Nationwide Cohort Study.

BACKGROUND & AIMS: Obesity has been linked to various detrimental health consequences. While there is established evidence of a negative correlation between seafood consumption and obesity in adults, the current research on the association between seafood intake in childhood/adolescence and the risk of obesity is lacking. Our aim was to evaluate the association between seafood intake in childhood/adolescence and the risk of obesity in a Chinese nationwide cohort. METHODS: We utilized data from the China Health and Nutrition Survey (CHNS) from the year of 1997 to 2015. Seafood consumption was evaluated through 3-day 24-hour recalls. In our study, overweight/obesity status was determined based on the Chinese Criteria of Overweight and Obesity in School-age Children and Adolescents (WS/T 586-2018), while abdominal obesity status was determined according to the Chinese Criteria of Waist Circumference Screening Threshold among Children and Adolescents (WS/T 611-2018). RESULTS: During an average follow-up of 7.9 years, 404 cases developed overweight/obesity among 2206 participants in the seafood-overweight/obesity analysis, while 381 cases developed abdominal obesity among 2256 participants in the seafood-abdominal-obesity analysis. The high-consumer group was associated with 35% lower risk of overweight/obesity risk and 26% lower risk of abdominal obesity after fully adjusting for sociodemographic and lifestyle factors, compared with the non-consumer group. Considering different cooking methods, boiled seafood consumption was associated with 43% lower risk of overweight/obesity and 23% lower risk of abdominal obesity in the fully adjusted model, while stir-fried seafood did not demonstrate a statistical significance. CONCLUSION: Higher intake of seafood in childhood/adolescents, particularly in a boiled way, was associated with lower obesity risk.

Unfavorable food consumption in children up to school entry age: results from the nationwide German KiESEL study.

Introduction: Evidence points toward the early life being crucial for preventing nutrition-related diseases. As promotion of healthier food preferences in toddlerhood and preschool age might still modulate the trajectories of disease risk, understanding diet in these age groups is necessary. The objective was to analyze food consumption and diet quality of 1-5-year-old children living in Germany in relation to age and sex. Methods: Data from 890 children, a subsample of the representative, cross-sectional Children's Nutrition Survey to Record Food Consumption (KiESEL) conducted by the German Federal Institute for Risk Assessment in 2014-2017, were analyzed. Dietary data were collected using food records (3 consecutive plus 1 independent day). Diet quality was evaluated against the German food-based dietary guidelines (FBDG). Results: Consumption of unfavorable foods (e.g., sweets, soft drinks) exceeded the recommended maximum of 10% of energy intake (E%) by a multiple in all age and sex groups (medians: 24.8-35.8 E%). Preschoolers consumed more unfavorable foods than toddlers and boys more than girls. More than half of the children exceeded the recommendation for meat intake (medians: 2.3-3.2% of the total food consumption (%TFC) vs. 2 %TFC), especially preschoolers. In nearly all children, vegetable consumption was too low (medians: 4.2-4.5 %TFC vs. 12 %TFC). Also, milk/milk product consumption was below recommendations, more so in preschoolers (median: 12.0 %TFC ♂, 11.9 %TFC ♀ vs. 18 %TFC) than in toddlers (median: 16.1 %TFC ♂, 19.6 %TFC ♀). In toddlers and preschoolers with overweight or obesity, adherence to dietary recommendations of these food groups was largely similar to that of the total sample. Overall, 5-year-olds showed an unhealthier dietary pattern than 1-year-olds, which already emerged at age 2 years and became more evident at age 3 years. Discussion: An adverse dietary pattern arises and even deteriorates at a very young age, showing sex-specific aspects. High attention from public health and research needs to be given to toddlerhood and even earlier life phases, e.g., to develop more age-specific FBDGs, aiming at reducing unhealthy food consumption.

Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19.

PURPOSE: We quantified levels of ultra-processed food (UPF) consumption and investigated consumption patterns in a representative sample of UK adolescents. METHODS: We used data from 4-day food diaries from adolescents in the UK National Diet and Nutrition Survey (NDNS) (2008/09-2018/19). UPF were identified using the NOVA classification. We estimated the percentage of Total Energy Intake (%TEI) and the absolute weight (grams). Linear regression models quantified differences in UPF consumption across survey years and its association with participant's individual characteristics. This was an analysis of the repeated cross-sectional data from the UK NDNS Rolling Programme waves 1-11 (2008/09-2018/19). A total of 2991 adolescents (11-18y) with complete information on dietary intake were included. RESULTS: Mean UPF consumption was 861 (SD 442) g/d and this accounted for 65.9% (SD 13.4%) of TEI. Between 2008 and 2019, mean UPF consumption decreased from 996 to 776 g/d [ - 211 (95%CI - 302; - 120)] and from 67.7% to 62.8% of TEI [ - 4.8% (95%CI - 8.1; - 1.5)]. Higher %TEI was consumed by adolescents with lower socioeconomic status; white ethnicity and living in England North. A higher weight of UPF consumption (g/d) was associated with being male, white, age 18y, having parents with routine or manual occupation, living in England North, and living with obesity. CONCLUSION: Average energy intake from UPF has decreased over a decade in UK adolescents. We observed a social and regional patterning of UPF consumption, with higher consumption among adolescents from lower socioeconomic backgrounds, from a white ethnicity and living in England North. Our findings suggest inequalities associated with UPF intake and factors that might lie beyond individual choice.

Relationship between Household Shared Meal Frequency and Dietary Intake among Men and Women Aged ≥20 Years: Cross-Sectional Analyses Based on 2018 and 2019 National Health and Nutrition Surveys in Japan.

This study aimed to examine the relationship between the frequency of household shared meals and the intake of 17 food groups and 21 nutrients. Participants were 3310 men and 3386 women ≥20 years old living in a household of ≥2 members from 2018 and 2019 National Health and Nutrition Surveys in Japan. A one-day household dietary record was used to classify an individual's shared meal frequency and dietary intake. A shared meal is defined as an eating occasion (i.e., breakfast, lunch, and dinner) where ≥1 food item-other than sugars, fats and oils, beverages, and condiments-was recorded with an assigned approximated shared proportion. The shared meal frequency for each individual was classified into one of four categories: 0, 1, 2, and 3 times/day. Dietary intake was compared across the shared meal categories adjusted for age, occupation, household size, meal skipping, snacking, residential areas, and within-household correlations. Both men and women who had more frequent shared meals showed higher intakes of potatoes, vegetables, mushrooms, and condiments but less confectioneries and beverages. A higher shared meal frequency was also related to a higher intake of many (12/21) nutrients (e.g., protein, dietary fiber, and potassium). However, in women, there was a positive association between shared meal frequency and sodium intake. A higher frequency of household shared meals may be related to a more favorable dietary intake; except for concerns about sodium intake in women.

Long-term relatively high dietary manganese intake could decrease the risk of hyperuricemia: Twelve-year distinct dietary manganese consumption trajectories and the China Health and Nutrition Survey.

BACKGROUND AND AIM: Currently, the relationship between dynamic changes in dietary manganese (Mn) intake and risk of hyperuricemia (HU) is still unclear. This study aimed to identify dietary Mn consumption trajectories in the Chinese adults and assess their relation with the risk of HU. METHODS AND RESULTS: Cohort data from the China Health and Nutrition Survey (CHNS) 1997-2009 were employed in this study. Overall, 6886 adult participants were included. Participants were designated into subgroups based on the trajectories of dietary Mn consumption by sex. Cox proportional hazard models were used to explore the associations between different trajectories and the risk of HU. For men, compared with low stable trajectory group, moderate to high trajectory group was significantly related to reduced risk of HU (HR = 0.61, 95% CI: 0.38 to 0.98) with adjustment for covariates. TC, HDL-C, ApoB, and TG exerted partial regulation function between trajectories and HU. For women, compared with low stable trajectory group, high stable trajectory group was significantly related to reduced risk of HU (HR = 0.76, 95% CI: 0.60 to 0.95) with adjustment for covariates. Similarly, TC, HDL-C, ApoB, and ApoA exerted partial regulation function between trajectories and HU. CONCLUSIONS: Long-term relatively high dietary Mn consumption may have a protective effect against HU in Chinese adults. The differences in HU-related factors among different dietary Mn intake trajectories partially regulated the association between these trajectories and HU.

Association between serum uric acid levels and dietary fiber intake in adults: the Korea national health and nutrition examination survey (KNHANES VII, 2016-2018).

BACKGROUND: Hyperuricemia could be a risk for various chronic diseases, and it could be largely corrected by diet control. This study was a nationwide cross-sectional study to investigate the association between serum uric acid level and dietary fiber intake. METHODS: This study analyzed data based on the Korean National Health and Nutrition Examination Survey conducted from 2016 to 2018. Adults over 20 years of age with normal renal function, defined as an estimated glomerular filtration rate (eGFR) over 30mL/min/1.73m2, were included. The criteria for hyperuricemia were ≥ 7 mg/dL in men and ≥ 6 mg/dL in women. Data regarding dietary intake were obtained using the 24-hour recall method. RESULTS: A total of 15,278 subjects (6,455 males/8,823 females) were analyzed. The prevalence of hyperuricemia was 19.3% in men and 6.8% in women. There were significant, negative associations between serum uric acid and total fiber intake in both men and women. Consuming more than 27.9 g of dietary fiber in men and 20.7 g in women reduced the risk of hyperuricemia by approximately 30% with odds ratios of 0.72 (0.62-0.83) and 0.71 (0.56-0.88) in men and women, respectively. With regard to the risk reduction by the type of dietary fiber, cereal fiber was significantly identified in both men and women, while fruit fiber was only significant in men. In the subgroup analysis, this association remained significantly in young and metabolically healthy populations with normal weight. CONCLUSIONS: Dietary fiber intake was inversely associated with serum uric acid levels. This relationship was particularly significant in metabolically healthy young adults.

Associations of mixed metal exposure with chronic kidney disease from NHANES 2011-2018.

Metals have been proved to be one of risk factors for chronic kidney disease (CKD) and diabetes, but the effect of mixed metal co-exposure and potential interaction between metals are still unclear. We assessed the urine and whole blood levels of cadmium (Cd), manganese (Mn), lead (Pb), mercury (Hg), and renal function in 3080 adults from National Health and Nutrition Survey (NHANES) (2011-2018) to explore the effect of mixed metal exposure on CKD especially in people with type 2 diabetes mellitus (T2DM). Weighted quantile sum regression model and Bayesian Kernel Machine Regression model were used to evaluate the overall exposure impact of metal mixture and potential interaction between metals. The results showed that the exposure to mixed metals was significantly associated with an increased risk of CKD in blood glucose stratification, with the risk of CKD being 1.58 (1.26,1.99) times in urine and 1.67 (1.19,2.34) times in whole blood higher in individuals exposed to high concentrations of the metal mixture compared to those exposed to low concentrations. The effect of urine metal mixture was elevated magnitude in stratified analysis. There were interactions between urine Pb and Cd, Pb and Mn, Pb and Hg, Cd and Mn, Cd and Hg, and blood Pb and Hg, Mn and Cd, Mn and Pb, Mn and Hg on the risk of CKD in patients with T2DM and no significant interaction between metals was observed in non-diabetics. In summary, mixed metal exposure increased the risk of CKD in patients with T2DM, and there were complex interactions between metals. More in-depth studies are needed to explore the mechanism and demonstrate the causal relationship.

[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.

The relationship between proportions of carbohydrate and fat intake and hyperglycemia risk in Chinese adults.

OBJECTIVE: To address the relationship between the proportions of carbohydrates and fat and hyperglycemia in the Chinese population. DESIGN: A cross-section research involving data from the China Health and Nutrition Survey in 2009, and nutritional status and health indicators were mainly focused. SETTING: China. PARTICIPANTS: 8197 Chinese individuals aged over 16 years, including 1345 subjects had a low carbohydrate and high fat diet (LCHF), 3951 individuals had a medium proportion of carbohydrate and fat (MPCF) diet, 2660 participants had a high carbohydrate and low fat (HCLF) diet and 241 people had the very high carbohydrate and low fat (VHCLF) diet. RESULTS: Subjects with the HCLF diet were significantly associated with an increased risk of hyperglycemia (OR:1.142, 95%CI:1.022-1.276) when compared with the individuals with the MPCF diet. Meanwhile, people with a VHCLF diet had a higher risk of hyperglycemia (OR:1.829, 95%CI:1.377-2.429). In contrast, the association between participants with an LCHF diet and hyperglycemia was not significant (OR:1.082, 95%CI:0.942-1.243) with adjusting a series of confounding factors. Furthermore, people with a VHCLF diet were significantly associated with a higher risk of hyperglycemia in the major energy levels and social characteristics subgroup. CONCLUSION: We found the HCLF and VHCLF diets were significantly associated with a high risk of hyperglycemia. And, the association between LCHF diets and the risk of hyperglycemia was not significant.

Trends and Characteristics of Brown Rice Consumption among Adults in Japan: An Analysis of the National Health and Nutrition Surveys, 2012-2019.

Brown rice is a familiar whole grain in Japan. We examined national trends in brown rice consumption among Japanese adults aged ≥20 years old, using individual-level data from the National Health and Nutrition Surveys conducted between 2012 and 2019. We employed multivariable logistic regression to identify factors associated with brown rice consumption. The 95th percentile of daily brown rice intake remained at 0.0 g throughout the study period. The percentage of brown rice consumers increased from 1.8% (95% confidence interval: 1.6-2.1) in 2012 to 2.6% (95% confidence interval: 2.0-3.4) in 2019. Compared with individuals who consumed only white rice, brown rice consumers had significantly higher mean intake levels of macronutrients, legumes, vegetables, fruits, and nuts. Brown rice consumption was positively associated with certain sociodemographic characteristics (being female, older age, residing in a major city, living without very young children, and having higher education levels) and health behaviors (lower body mass index, engaging in regular exercise, and being a former or never smoker). Despite its potential nutritional benefits in balanced diets, only a small fraction of adults in Japan consume brown rice, indicating a need for further promotion, particularly among individuals with characteristics associated with brown rice consumption.

Nutrition survey methods and food composition database update of the Korean Genome and Epidemiology Study.

This study presents the nutrition survey methods and the updated food composition database for the Korean Genome and Epidemiology Study (KoGES). The KoGES, which is the largest and longest cohort study in Korea, aims to identify genetic and environmental factors associated with chronic diseases. This study has collected dietary data using a validated semi-quantitative food frequency questionnaire and/or the 24-hour recall method. However, these dietary survey methods use different food composition databases, and their nutritional values are out of date. Therefore, it became necessary to update the food composition database by revising nutrient analysis values to reflect improvements in the performance of food ingredient analysis equipment, revising international values to analysis values of Korean agricultural products, adjusting nutrient units, and adding newly reported nutrients related to chronic diseases. For this purpose, we integrated the different food composition databases used in each nutrition survey, updated 23 nutrients, and expanded 48 new nutrients for 3,648 food items using the latest reliable food composition databases published by national and international institutions. This revised food composition database may help to clarify the relationship between various nutrients and chronic diseases. It could serve as a valuable resource for nutritional, epidemiological, and genomic research and provide a basis for determining public health policies.

Cross-continental national nutrition surveys: a narrative review.

Many countries use national nutrition surveys (NNSs) to assess their population's health and nutrition needs. However, NNS aims, approaches, tools, and measurements vary among countries. To date, there has been no review evaluating the NNSs and their practices worldwide to help conduct future NSSs. Therefore, this narrative review was conducted to 1) explore and tabulate current NNSs in five continents (Asia, Europe, Africa, North America, and Australia) and 2) help lay the foundation for establishing clear guidelines for future NNSs. The NNSs were identified using two approaches. First, an electronic database search was conducted with key terms in PubMed database. Second, a general web-based search on the survey webpages of governmental organizations was conducted using the same key terms to identify eligible surveys. The review included general adult population (≥ 18 years) with a cross-sectional design, excluding NNSs related to household-only surveys, specific age groups, or insufficient sample sizes. A total of 41 NNSs were identified in 37 countries across four continents: Asia (n = 15), Europe (n = 21), North America (n = 3), and Australia (n = 2). Broad differences between the surveys were identified, including survey purposes and designs, definitions of geographic areas and target groups, and dietary assessments. Currently, there are 26 ongoing NNSs, while 15 have ended. Among the ongoing NNSs, the cycles of the surveys were either at regular intervals (n = 8) or irregular intervals (n = 8). Of the 41 surveys, 24-h dietary recalls were used in 27 surveys, while only 6 surveys used diet diaries and 8 surveys relied on FFQs. Some surveys (n = 17) utilized multiple tools to assess dietary intake. Most of the surveys that assessed biochemical status (n = 12) focused on blood glucose, haemoglobin A1c (HbA1c), and lipid status, whereas some surveys (n = 6) tested for vitamin and mineral status in blood and/or urine samples. The review identified key characteristics, time frames, sampling methods, and dietary and physical assessment methods obtained from different surveys worldwide. The information organized in this review will be important for researchers, policymakers, and public health programme developers in developing and improving NNS.

Analysis of the Association between Protein Intake and Disability-Adjusted Life Year Rates for Alzheimer's Disease in Japanese Aged over 60.

With advancements in medical technology, the structure of disease is shifting from acute illnesses to chronic conditions, such as Alzheimer's disease (AD). Consequently, there is an escalating need for evaluations that discourse on the potential effects on healthy life years, as well as disease onset. We aimed to evaluate the associations with AD disability-adjusted life year (AD-DALY) rates and protein intake by sex and age group. For the analysis, we used representative values for males and females in their 60s and aged over 70, extracted from the public dataset of the Global Burden of Disease Study and the National Health and Nutrition Survey in Japan, covering the years 1990 to 2019. In order to evaluate the association between AD-DALY rates and protein intake, we analyzed correlations and stratified multiple regression models. Additionally, we simulated alterations in AD-DALY rates associated with changes in protein intake by utilizing stratified multiple regression models. AD-DALY rates and protein intake indicated significant negative correlations across all sex and age groups. In stratified multiple regression models, significant associations were found between higher protein intake and lower AD-DALY rates in females. In the simulation, when protein intake was increased to 1.5 g/kg/day, AD-DALY rates decreased by 5-9 percent compared with 2019. However, the association between intake of animal and plant protein and AD-DALY rates were found to vary based on sex and age group. The present study suggests the possibility to improve AD-DALY rates by increasing population average protein intake levels in a recommended range.

South East Asian Nutrition Surveys (SEANUTS) II - a multi-country evaluation of nutrition and lifestyle indicators in children aged 12 years and below: Rationale and Design.

OBJECTIVE: To assess the nutritional status, growth parameters and lifestyle behaviours of children between 0.5-12 years in nationally representative samples in Malaysia, Indonesia, Thailand, and Vietnam. DESIGN: A cross-sectional study was conducted in the four countries, between May 2019 and April 2021. Data collected can be categorized into four categories: (1) Growth - anthropometry, body composition, development disorder, (2) Nutrient intake and dietary habits - 24-hour dietary recall, child food habits, breast feeding and complementary feeding, (3) Socio-economic status - food insecurity and child health status/environmental, and (4) Lifestyle behaviours - physical activity patterns, fitness, sunlight exposure, sleep patterns, body image and behavioural problems. Blood samples were also collected for biochemical and metabolomic analyses. With the pandemic emerging during the study, a COVID-19 questionnaire was developed and implemented. SETTING: Both rural and urban areas in Malaysia, Indonesia, Thailand, and Vietnam. PARTICIPANTS: Children who were well, with no physical disability or serious infections/injuries and between the age of 0.5-12 years old were recruited. RESULTS: The South East Asian Nutrition Surveys II recruited 13,933 children. Depending on the country, data collection from children were conducted in schools and commune health centres, or temples, or sub-district administrative organizations. CONCLUSIONS: The results will provide up-to-date insights into nutritional status and lifestyle behaviours of children in the four countries. Subsequently, these data will facilitate exploration of potential gaps in dietary intake among Southeast Asian children and enable local authorities to plan future nutrition and lifestyle intervention strategies.

Association Between Serum Klotho and Chronic Obstructive Pulmonary Disease in US Middle-Aged and Older Individuals: A Cross-Sectional Study from NHANES 2013-2016.

Purpose: This study sought to examine the potential association between serum Klotho levels and the prevalence of COPD in the United States. Patients and Methods: This study was a cross-sectional analysis involving 4361 adults aged 40-79 years participating in the US National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2016. Our investigation utilized multivariate logistic regression and restricted cubic spline (RCS) regression to explore the potential correlation between serum Klotho concentrations and the prevalence of COPD. Additionally, we conducted stratified and interaction analyses to evaluate the consistency and potential modifiers of this relationship. Results: In this study encompassing 4631 patients (with an average age of 57.6 years, 47.5% of whom were male), 445 individuals (10.2%) were identified as having COPD. In the fully adjusted model, ln-transformed serum Klotho was negatively associated with COPD (OR = 0.71; 95% CI: 0.51-0.99; p = 0.043). Meanwhile, compared with quartile 1, serum Klotho levels in quartiles 2-4 yielded odds ratios (ORs) (95% CI) for COPD were 0.84 (0.63~1.11), 0.76 (0.56~1.02), 0.84 (0.62~1.13), respectively. A negative relationship was observed between the ln-transformed serum Klotho and occurrence of COPD (nonlinear: p = 0.140). the association between ln-transformed serum Klotho and COPD were stable in stratified analyses. Conclusion: Serum Klotho was negatively associated with the incidence of COPD, when ln-transformed Klotho concentration increased by 1 unit, the risk of COPD was 29% lower.

A scoping review of dietary assessment questionnaires potentially suitable for assessing habitual dietary intake in the National Health and Nutrition Survey, Japan.

This scoping review aimed to identify questionnaire-based dietary assessment methods for use in the National Health and Nutrition Survey (NHNS) in Japan. The search was conducted in three databases (PubMed, Web of Science, and Ichushi) to identify questionnaire such as food frequency questionnaire and dietary history questionnaire validated against dietary recalls or food records for the intakes of both food groups and nutrients among Japanese adults. Study quality was assessed based on previously developed criteria. We extracted the questionnaire characteristics and the design and results of the validation studies. We identified 11 questionnaires, with the number of food items ranging from 40 to 196, from 32 articles of good quality. In the validation studies, participants were aged 30-76 years and 90% of the articles used ≥3 d dietary records as reference. The number of nutrients and food groups with a group-level intake difference within 20% against the reference method ranged from 1 to 30 and 1 to 11, respectively. The range of mean correlation coefficients between questionnaire and reference methods were 0.35-0.57 for nutrients and 0.28-0.52 for food groups. When selecting a survey instrument in the NHNS from the 11 existing questionnaires identified in this study, it is important to select one with high group-level comparison and correlation coefficient values on the intended assessment items after scrutinizing the design and results of the validation study. This review may serve as a reference for future studies that explore dietary assessment tools used for assessing dietary intake in specific representative populations.

A high consumption of ultra-processed foods is associated with higher total mortality in an adult Mediterranean population.

BACKGROUND & AIMS: The consumption of ultra-processed foods (UPF) has been associated with higher all-cause and cardiovascular disease (CVD) mortality, although this association has not been sufficiently investigated in Mediterranean populations. We aimed to evaluate the association between UPF consumption and all-cause, CVD and cancer mortality in an adult population in Spain. METHODS: We analysed data from 1,538 participants aged 20 years and above in the Valencia Nutrition Survey in 1995. Diet was assessed at baseline using a validated food frequency questionnaire and the consumption of UPF was calculated using the NOVA system. Information on socio-demographic characteristics, lifestyles, and presence of diseases was also collected at baseline. Cause of death was ascertained during an 18-year follow-up period. We used Cox regression and competing risk models as proposed by Fine and Gray's to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (95 %CI). RESULTS: After 18 years of follow-up, we documented 312 deaths (36.5 % of CVD and 25.6 % of cancer). Compared with participants in the lowest tertile of UPF consumption, those in the highest tertile showed 40 % higher risk of all-cause mortality, HR 1.40 (95 %CI: 1.04-1.90), and evidence of a higher CVD mortality, HR 1.39 (95 %CI: 0.80-2.41) and of cancer mortality, HR 1.53 (95 %CI: 0.83-2.82). CONCLUSIONS: This study suggests that a high UPF consumption is associated with a higher all-cause mortality in a Mediterranean population after a long follow-up period. Considering the increase in UPF consumption and their detrimental health effects on mortality, these results should be confirmed by other studies in other populations.

Risk Factors of Premature Atherosclerotic Cardiovascular Disease in China: A Longitudinal Analysis of the China Health and Nutrition Survey Cohort.

The burden of premature atherosclerotic cardiovascular disease (ASCVD) has increased rapidly in China. Using the China Health and Nutrition Survey (CHNS) data, we assessed the risk factors of premature ASCVD (age of diagnosis: <55 years for men and <65 years for women). Propensity score matching was used to reduce selection bias. Multivariable Cox proportional-hazards analyses indicated that factors associated with increased risk of premature ASCVD included hypertension (adjusted hazard ratio [HRadj.] = 1.68), obesity (HRadj. = 1.64), and high carbohydrate intake (HRadj. = 1.46). Conversely, participants with medical insurance (HRadj. = 0.42), high urbanization index (HRadj. = 0.53), and high household income (HRadj. = 0.48) had lower risk of premature ASCVD. When comparing premature vs non-premature ASCVD participants, those who were obese (HRadj. = 2.08) or living in more urbanized areas had higher hazards of early onset (HRadj. = 2.29).

[An examination of relevant factors attributable to child health, food behavior, and lifestyle concerns of parents with infants aged at least 18 months: With a view to expanding into Shokuiku (food and nutrition education)].

Objectives　This study focused on food after weaning and examined the children's diet and home environmental factors that influence parents' concerns during health checkup for infants (aged 1.6 and 3 years).Methods　In the analysis, 646 participants, excluding invalid responses, who cooperated with the survey during health checkup for 1.6- and 3-year-old in the Tohoku, Chubu, and Chugoku regions from March 2019 to January 2020, were included. The survey included 56 items of dietary, lifestyle, and health concerns (yes/no answers), child attributes, and frequency of food intake (six options, 18 types). Concern factors were extracted by factor analysis. The association between the worry scores and each factor was analyzed.Results　The 1.6- and 3-year-olds were associated with high scores for (health awareness and lifestyle) and low fruit intake, high salty snacks intake, and low subjective economic status, high scores for (diet content and atmosphere) and low intakes of carotene-rich vegetables, other vegetables, seaweed, and fruits, high scores for (interest and motivation in food) and low carotene-rich vegetables intake, high scores for (food experience and behavior) and high cereals (bread) intake, low subjective economic status. The 3-year-olds were associated with high scores and being boys.Conclusion　We extracted four worry factors that parents with children after the weaning period have and clarified the factors related to each factor and group characteristics.