China Health And Nutrition Survey Research Articles

Children’s education and parents’ dietary nutrient intake: an empirical study based on rural China

This paper, taking the middle-aged and elderly parents in rural families of China as the subject, studies the impact of children’s education on parents’ dietary nutrient intake. After analyzing the data in China Health and Nutrition Survey (CHNS) 2011, this study discovers that China’s rural children’s higher educational level exerts a significant positive impact on the improvement of parents’ food consumption, nutrient intake and diet quality. This indicates that the improvement of rural education can be an effective approach to increase dietary nutrient intake of China’s rural population. The policy implication of this study is to further develop rural basic education, consolidate the coverage of compulsory education, and incorporate nutrition education into national education system.

Associations of specific dietary unsaturated fatty acids with risk of overweight/obesity: population-based cohort study.

The role of specific unsaturated fatty acids (FAs) in the development of overweight/obesity remains unclear in the general population. Here, we aimed to explore the associations of different types of unsaturated FAs with overweight/obesity risk among the Chinese population. Eight thousand seven hundred forty-two subjects free of overweight/obesity at entry in the China Health and Nutrition Survey (CHNS) were followed up until 2015. Dietary unsaturated FAs were assessed by 3-day 24-h recalls with a weighing method in each wave. Cox regression models were used to obtain the hazard ratios (HRs) and 95% confidence intervals (CIs) for overweight/obesity risk associated with unsaturated FAs. During a median follow-up of 7 years, 2,753 subjects (1,350 males and 1,403 females) developed overweight/obesity. Consuming more monounsaturated FAs (MUFAs) was associated with a lower risk of overweight/obesity (highest vs. lowest quartile: HR 0.80, 95% CI 0.67-0.96; P-trend = 0.010). Similar inverse associations were observed for plant-MUFAs (HRQ4vsQ1 0.83, 95% CI: 0.73-0.94; P-trend = 0.003) and animal-MUFAs (HRQ4vsQ1 0.77, 95% CI: 0.64-0.94; P-trend = 0.004), total dietary oleic acid (OA) (HRQ4vsQ1 0.66, 95% CI: 0.55-0.79; P-trend <0.001), plant-OA (HRQ4vsQ1 0.73, 95% CI: 0.64-0.83; P-trend <0.001) and animal-OA (HRQ4vsQ1 0.68, 95% CI: 0.55-0.84; P-trend <0.001). In addition, the intakes of n-3 polyunsaturated FAs (PUFAs) (HRQ4vsQ1 1.24, 95% CI: 1.09-1.42; P-trend = 0.017) and α-linolenic acid (ALA) (HRQ4vsQ1 1.22, 95% CI: 1.07-1.39; P-trend = 0.039) but not marine n-3 PUFAs were positively linked to overweight/obesity risk. Consumption of n-6 PUFAs (HRQ4vsQ1 1.13, 95% CI: 0.99-1.28; P-trend = 0.014) and linoleic acid (LA) (HRQ4vsQ1 1.11, 95% CI: 0.98-1.26; P-trend = 0.020) had marginal and positive relationships with the incidence of overweight/obesity. N-6/n-3 PUFA ratio ranging from 5.7 to 12.6 was related to higher risk of overweight/obesity. Higher dietary intake of MUFAs was associated with lower overweight/obesity risk, which was mainly driven by dietary OA from either plant or animal sources. Intakes of ALA, n-6 PUFAs and LA were related to higher risk of overweight/obesity. These results support consuming more MUFAs for maintaining a healthy body weight among the Chinese population.

“First Kilometer” to realize common prosperity: impact of public bus expansion into villages on farmers’ income mobility

ABSTRACT Using data from the China Health and Nutrition Survey (CHNS) dated from 1991 to 2015, we assess the impact of public bus expansion into villages on income mobility of rural household, particularly, with low income. This paper finds that the income mobility of low-income households is suffered from the expansion of public buses in the rural areas. Due to the ‘crowding out’ effect, the low-income families are excluded from the non-agricultural employment brought by the public bus expansion, which nevertheless does not improve the agricultural production structure. This can explain why the low-income group has been marginalized during the process of urban-city integration in China. Improvement of the human capital can significantly alleviate the negative impact of public bus expansion on the low-income group in rural areas, while the child-care burden aggravates the issue. These results may also have policy implication for potential solutions to problems such as the ‘First Kilometer’ to realize common prosperity is not simply about the modernization in the infrastructure but also equalization of opportunities through cultivation of human capital.

The effect of rising food prices on nutrient intake among rural–urban migrants in China

PurposeThe purpose of this study is to assess the impact of rising food prices on food demand and nutrient intake among rural–urban migrants and whether such impact varies across income classes.Design/methodology/approachUsing data from the China Health and Nutrition Survey (CHNS), this study adopts a quadratic almost ideal demand system (QUAIDS) for food demand elasticity and an indirect estimation method for nutrient elasticity to investigate the effects of rising food prices on food demand and nutrient intake among rural–urban migrants.FindingsThe estimated results indicate that an increase in the price of pork alone would lead to a larger reduction in most nutrients among rural–urban migrants than other single targeted food group, and a simultaneous rise in the price of all food groups would have a remarkably adverse effect on the nutritional status of rural–urban migrants in comparison to the nutritional effects of a rise in one targeted food group. In addition, the nutritional effects of food prices across income classes show that the nutritional status is particularly vulnerable to rising food prices among low-income rural–urban migrants.Originality/valueThis paper focuses on analyzing the impact of rising food prices on the nutritional status of rural–urban migrants, a topic that is very limited in the literature. This study provides a fresh look at the effect of volatile food prices on food demand and nutrient intake among rural–urban migrants. The results indicate that income growth would have a remarkable positive effect on nutrient intake for rural–urban migrants, especially for low-income rural–urban migrants. However, an increment in nutrients due to a growth in income would not be far from enough to cover the reduction in nutrients as a result of a simultaneous rise in price of all the studied food categories at the same rate.

Association Between Dietary Copper Intake and Cognitive Decline: A Perspective Cohort Study in Chinese Elderly

The association between dietary copper (Cu) intake and cognitive decline remains uncertain. We aim to investigate the longitudinal association of dietary Cu with cognitive decline in Chinese elderly. A total of 3,106 Chinese adults aged older than or equal to 55 years from China Health and Nutrition Survey (CHNS) were included. Dietary nutrients information was collected by 24-hours dietary recalls in combination with a food-weighted method. The 5-year change rates in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified (TICS-m) was calculated as the last-survey score minus the baseline score, then divided by the follow-up time (unit, years) and multiplied by five. The median follow-up duration was 5.9 years. There was a nonlinear association of dietary Cu intake with the 5-year change rates in global or composite cognitive scores, with the inflection point at approximately 1.3 mg/day of dietary Cu intake. Accordingly, for the composite cognitive score, compared to the first quantile (<1.28 mg/day), those with dietary Cu in quantiles 2-8 (≥1.28 mg/day) had a significantly slower cognitive decline rate (B, 0.30; 95% CI, 0.13, 0.47). Similar results were found for the global cognitive score. Moreover, the inverse association between dietary Cu and cognitive decline was stronger in those with lower dietary fat intake and lower levels of physical activity (All p-interactions <0.05). There was a nonlinear inverse association of dietary Cu intake with cognitive decline in the elderly, with an inflection point at approximately 1.3 mg/day of dietary Cu intake.

Associations between cooking fuels and hypertension prevalence in Chinese adults: A prospective cohort analysis focusing on fuel transitioning

BackgroundUsing polluting cooking fuels is a suggested risk factor for hypertension. Transitioning to clean cooking fuels has occurred widely in China in the past 30 years. This provides an opportunity to examine whether the transition could reduce hypertension risk and to ascertain the inconsistent literature on the relationship between cooking fuels and hypertension prevalence. MethodsInitiated in 1989, the China Health and Nutrition Survey (CHNS) enrolled participants from 12 provinces in China. By 2015, nine waves of follow-up have been conducted. Based on self-reported cooking fuels, participants were classified into persistent clean fuel users, persistent polluting fuel users and those who transitioned from polluting fuels to clean fuels. Hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current use of antihypertension medication. FindingsAmong 12,668 participants, 3963 (31.28%) were persistent polluting fuel users; 4299 (33.94%) transitioned to clean fuels; and 4406 (34.78%) were persistent clean fuel users. During the period of follow-up (7.8 ± 6.1 years), hypertension was diagnosed in 4428 participants. Compared to persistent clean fuel users, persistent polluting fuel users had a higher risk for hypertension (hazard ratio [HR] 1.69, 95%CI 1.55–1.85), while those transitioned to clean fuels did not. The effects were consistent by gender and urbanicity, respectively. The HRs for hypertension were 1.99 (95%CI 1.75–2.25), 1.55 (95%CI 1.32–1.81) and 1.36 (95%CI 1.13–1.65) among those persistent polluting fuel users aged 18–44, 45–59 and ≥60 years old, respectively. InterpretationTransitioning from using polluting fuels to clean fuels prevented an increase in hypertension risk. The finding highlights the importance of promoting the fuel transition as a risk-reduction strategy for reducing the disease burden from hypertension.

The positive association between white blood cell count and metabolic syndrome is independent of insulin resistance among a Chinese population: a cross-sectional study.

The association between white blood cells (WBCs) and metabolic syndrome (MS) has been consistently reported in previous studies using regional samples. However, it remains unclear whether this relationship has urban-rural differences and is independent of insulin resistance using a large-scale representative sample. Additionally, accurate risk prediction in patients with MS is crucial for developing targeted interventions to enhance the quality of life and prognosis of patients. The aims of this study were (1) to examine the cross-sectional association between WBCs and MS among the national population and analyze the urban-rural difference and whether insulin resistance plays a moderator effect in this association and (2) to describe the performance to predict MS using machine learning (ML) models. A cross-sectional study was performed using 7,014 data from the China Health and Nutrition Survey (CHNS). WBCs were analyzed using an automatic hematology analyzer and MS was defined according to the criteria of the American Heart Association scientific statements of 2009. Variables on sociodemographic characteristics (sex, age, and residence), clinical laboratory (BMI and HOMA-IR), and lifestyle characteristics (smoking and drinking status) were used to construct ML models to predict MS [logistic regression (LR) and multilayer perceptron (MLP) neural network]. We found that 21.1% of participants (1,479/7,014) were classified as having MS. In multivariate logistic regression (including insulin resistance), the result revealed a significant positive association between WBCs and MS. The odds ratios (95% CI) for MS with increasing WBC level were 1.00 (reference), 1.65 (1.18, 2.31), and 2.18 (1.36, 3.50) (p for trend: 0.001). For two ML algorithms, two models showed adequate calibration and good discrimination, but the MLP showed better performance (AUC-ROC = 0.862 and 0.867). With the aim of confirming the association between WBCs and MS, this cross-sectional study is the first to show that maintaining normal WBC count levels is helpful to prevent the development of MS, and this association is independent of insulin resistance. The results also showed that the MPL algorithm represented a more prominent predictive performance to predict MS.

Association between Dietary Acid Load and Hyperuricemia in Chinese Adults: Analysis of the China Health and Nutrition Survey (2009).

This study evaluates the association between dietary acid load (DAL) and hyperuricemia in Chinese adults. The China Health and Nutrition Survey (CHNS) in 2009 was used in this cross-sectional study. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were applied to estimate DAL. A multiple logistic regression model was used to test the relationship between DAL and hyperuricemia risk. A total of 7947 participants were included in this study, of whom 1172 had hyperuricemia. The PRAL score was positively related to the prevalence of hyperuricemia, even when potential covariates were taken into account. In comparison with Q1, the ORs were 1.12 (95% CI, 0.92-1.38), 1.20 (95% CI, 0.97-1.47) and 1.42 (95% CI, 1.16-1.75) in Q2, Q3 and Q4. However, there was no significant relationship between NEAP scores and hyperuricemia. Every 10 g increase in energy-adjusted fat, protein and animal protein intakes caused a 10%, 17% and 18% increase in hyperuricemia risk, respectively (OR: 1.10, 95% CI: 1.04-1.16; OR: 1.17, 95% CI: 1.11-1.25; OR: 1.18, 95% CI: 1.12-1.24, respectively). An obvious linear correlation was also suggested by the restricted cubic spline. Hyperuricemia risk was associated with higher PRAL among Chinese adults. This means that a diet low in PRAL scores could be a very valuable uric acid-lowering dietary pattern.

Bidirectional mediation of evening energy proportion and chronotype on their associations with blood lipid levels in a Chinese population

ABSTRACT The bidirectional relationship between chronotype and meal energy distribution, and the effect of their relationship on blood lipid level has not been investigated. This study aims to test and compare the bidirectional mediating effects of chronotype and meal energy distribution on blood lipid levels. Data of 9376 adult participants from 2018 wave of the China Health and Nutrition Survey (CHNS) were analysed. Two mediation models were tested and compared: one with Evening energy proportion (Evening EI%) as mediator of the association between adjusted mid-sleep time on free days (MSFa) and blood lipid levels and the other with MSFa as mediator of the association of Evening EI% with blood lipid levels. The mediating effect of Evening EI% on the association between MSFa and TC, LDL-C and non-HDL-C were significant (p < .001, p = .001, and p = .002, respectively). The mediating effect of MSFa on the association between Evening EI% and TC, LDL-C and non-HDL-C were significant (p = .006, p = .035, and p < .001 respectively). Evening EI% had a larger standardized mediation effect compared to MSFa. The bidirectional mediation effect suggests a reinforcement mechanism, in which later chronotype and higher Evening EI% reciprocally influence their negative impact on elevated blood lipid levels, leading to higher risk of cardiovascular diseases in the general population.

L-shaped association between dietary zinc intake and the risk of developing cardiovascular disease in Chinese adults: A cohort study.

Although the association of zinc (Zn) with cardiovascular disease (CVD) has been studied, no consensus has been reached on this relationship, particularly dietary Zn intake. The purpose of this study was to assess the effect of dietary Zn intake on the risk of CVD and to analyze whether this effect varied according to zinc consumption using representative data from China. 11,470 adults from the China Health and Nutrition Survey (CHNS) were eventually enrolled. The dietary information was collected by the 3 day 24-h dietary recalls combined with dietary weighting method. CVD was defined as participants with self-reported physician-diagnosed apoplexy and/or myocardial infarction during the follow-up. Cox regression was used to calculate the hazard ratios (HRs) of CVD with 95% confidence intervals. Restricted cubic spline function plus Cox regression was used to visualize the influence trend of dietary Zn intake on new-onset CVD and to test whether this trend is linear. 2-segment Cox regression was established to address the nonlinear trend. 431 participants developed CVD, including 262 strokes and 197 myocardial infarctions. Compared with the lowest quintile (Q1), the adjusted hazard ratios and 95% confidence interval (CI) of CVD in Q2 to Q5 of dietary Zn intake were 0.72 (0.54, 0.97), 0.59 (0.42, 0.81), 0.50 (0.34, 0.72) and 0.44 (0.27, 0.71), respectively. The influence trend of dietary Zn intake on new-onset CVD was nonlinear and L-shaped. When dietary Zn intake <13.66 mg/day, increased dietary Zn intake was significantly associated with decreased risk of developing CVD (HR = 0.87, 95% CI: 0.82-0.92, p-value <0.0001). An L-shaped trend was observed between dietary Zn intake and the risk of developing CVD, indicating that dietary Zn intake should be improved moderately, but not excessively, for the benefit of cardiovascular disease.

Multidimensional Relative Poverty in China: Identification and Decomposition

This paper aims to study the change and decomposition of multidimensional relative poverty in China. The data we use are from the China Health and Nutrition Survey (CHNS). The data cover 12 provinces in China and span a long period, from reform to precise poverty alleviation. The results show that the multidimensional relative poverty index presents a change pattern of “gradual rise (1991–2004)-decline (2004–2011)-rise again (after 2011)”. The dimensions of education, income, and employment contribute more to multidimensional relative poverty, followed by health and living standards. Multidimensional relative poverty is more severe in rural areas, central and western regions, women, and the elderly. The “incidence of poverty effect” is the main factor in the changes in multidimensional relative poverty, and its contribution is higher than the “intensity of poverty effect”.

Relationship between novel anthropometric indices and the incidence of hypertension in Chinese individuals: a prospective cohort study based on the CHNS from 1993 to 2015

Background:Recently, novel anthropometric indices (AHIs), including the body roundness index (BRI) and a body shape index (ABSI), were proposed to evaluate a subject’s nutritional status and metabolic disorders. In the present study, we mainly analyzed the relationship between AHIs and the incidence of hypertension and preliminarily compared their abilities to discriminate hypertension incidence in the Chinese population from the China Health and Nutrition Survey (CHNS).Methods:A total of 12,154 participants were included in this longitudinal study. The age range of this cohort was 18–94 years old (mean age: 40.73 ± 13.85 years old). 4511 participants developed hypertension during a median of 7.00 years of follow-up. Cox regression analysis, stratified analysis, and interaction tests were used to analyze the relationship between AHIs and the incidence of hypertension. Time-dependent receiver operating characteristic (ROC) curves, integrated discrimination improvement (IDI) and net reclassification index (NRI) were calculated to appraise the AHIs’ discrimination value of new-onset hypertension.Results:Kaplan‒Meier curves demonstrated that the participants in higher quartiles of AHIs (ABSI or BRI) at baseline were at greater risk of hypertension incidence during the follow-up. After adjusting for confounding factors, multivariate Cox regression models showed that the quartiles of BRI were significantly associated with an increased risk of hypertension in the whole cohort but were relatively weak for ABSI quartiles (P for trend = 0.387). In addition, ABSI z score (HR = 1.08, 95% CI: 1.04–1.11) and BRI z score (HR = 1.27, 95% CI: 1.23–1.30) were positively associated with increased incident hypertension in the total population. Stratified analysis and interaction tests showed a greater risk of new-onset hypertension in those < 40 years old (HR = 1.43, 95% CI: 1.35–1.50) for each z score increase in BRI and a higher incidence of hypertension in participants who were drinkers (HR = 1.10, 95% CI: 1.04–1.14) for each z score increase in ABSI. In addition, we observed that the area under the curve for identifying hypertension incidence for BRI was significantly higher than that for ABSI at 4, 7, 11, 12, and 15 years (all P < 0.05). However, the AUC of both indices decreased over time. Furthermore, the addition of BRI improved the differentiation and reclassification of traditional risk factors with a continuous NRI of 0.201 (95% CI: 0.169–0.228) and an IDI of 0.021 (95% CI: 0.015–0.028).Conclusion:Increased ABSI and BRI were associated with an increased risk of hypertension in Chinese individuals. BRI performed better than ABSI in identifying the new onset of hypertension, and the discrimination ability of both indices decreased over time.

High-risk population and factors of stroke has changed among middle-aged and elderly Chinese-Evidence from 1989 to 2015.

Stroke is an acute cerebrovascular disease with high mortality and disability. This study aimed to investigate the trend of stroke prevalence from 1989 to 2015 in China, explore the transition of high-risk population and high-risk factors, and provide some evidence to develop more targeted stroke intervention strategies. We derived the baseline data from China Health and Nutrition Survey (CHNS). Participants responded to face-to-face interviews and examinations containing demographic information, behavioral health information, disease history, and physical examination. We applied chi-square test, shapley value decomposition model, and decision tree model to evaluate the changes of high-risk population and high-risk factors of stroke. Across 42,419 middle-aged and elderly residents, the prevalence of stroke was decreasing from 1989 to 2015. Hypertension was the leading risk factor of stroke, while its contribution rate was weakened with the increasing of medicine taking rate. As the second risk factor of stroke, the contribution of age decreased either. Meanwhile, the contribution rate of historical health factors, lifestyle factors, and regional factors, such as body mass index, diabetes, and living area to the impact of stroke was increasing. In addition, the first high-risk population of stroke changed from hypertension patients aged 75 years and above to without spouse residents living in stroke belt such as Beijing and Liaoning. The second risk population of stroke transformed from male hypertensive patients under 75 years old into male hypertensive patients living in urban. The third high-risk group turned from the elderly aged 75 and above into the female patients with hypertension and diabetes. This study demonstrated that the high-risk population and high-risk factors of stroke changed in China and revealed the direction and internal mechanism of transition of stroke. Targeted stroke intervention strategies should be renewed. Health education for the high-risk population of stroke should be carried out, healthy living habits need be advocated, and the use of antihypertensive drugs for the hypertensive patients should be standardized.

Diabetes Prediction Models Based on Machine Learning

Objective to compare the predictive efficacy of random forest, BP neural network, gradient boosting tree and plain Bayesian models for the prevalence of diabetes. Practical application: by measuring the basic indicators such as individual height, weight, triglyceride, etc., the model can be used to predict the probability of individual disease, and then targeted to improve some indicators of the body, to achieve the effect of diabetes prevention intervention, and to provide new ideas for diabetes prevention research. Methods Using the 2009 survey data from the China Health and Nutrition Survey (CHNS), the data for men and women were statistically analyzed by dividing them into four groups according to the visceral fat index (VAI). Subsequently, the processed samples were divided into training sets and test sets by 4:1, and four machine learning models, namely, random forest, BP neural network, gradient lifting tree, and naive Bayes, were constructed. The experiment was conducted using a five-fold cross validation method, and the prediction effect was evaluated through indicators such as sensitivity, accuracy, and AUC. Results One-way ANOVA showed that the differences in height, weight, waist circumference, triglycerides, high-density lipoprotein cholesterol, body mass index, fasting blood glucose, and glycosylated hemoglobin among different VAI quartile groups were statistically significant (P&lt;0.05). Comparison of prediction effects of four models: sensitivity 75.75%, 90.77%, 76.31%, 98.57%, accuracy 74.80%, 87.82%, 74.64%, 92.00%, AUC 0.713, 0.716, 0.668, 0.676, and Jorden index 0.34, 0.27, 0.22 and 0.21. Conclusion Based on the CHNS 2009 survey data, the BP neural network model has a better effect and stability in predicting diabetes.

Factors influencing blood pressure variability in postmenopausal women: evidence from the China Health and Nutrition Survey

ABSTRACT Background The aim is to identify the factors influencing blood pressure variability in postmenopausal women based on the China Health and Nutrition Survey (CHNS). Material and Methods The data on postmenopausal women between 1993 and 2015 were extracted from the CHNS. Group-based trajectory modeling was used to analyze the development track of blood pressure changes, based on which the subjects were separately divided into two groups for systolic blood pressure (SBP) and diastolic blood pressure (DBP). Univariate and multivariate analyzes were performed to analyze the factors influencing SBP and DBP. Results A total of 346 women were eligible for the study. Group-based trajectory modeling showed two different trajectories of blood pressure, including the low-level, slowly developed type and the high-level, rapidly developed, stable type of SBP, as well as the low-level, slowly developed type and the high-level, slowly developed type of DBP. In multivariate analysis, age (odds ratio [OR]: 1.118, 95% confidence interval [CI]: 1.082–1.156), body mass index (BMI) (OR: 2.239, 95%CI: 1.010–4.964), antihypertensive agents (OR: 7.293, 95%CI: 2.191–24.275), hip circumference (OR: 1.069, 95%CI: 1.014–1.128) and marital status (OR: 3.103, 95%CI: 1.028–9.361) were found to be the significant factors influencing SBP; age (OR: 1.067, 95%CI: 1.039–1.096), alcohol consumption (OR: 2.741, 95%CI: 1.169–6.429), antihypertensive agents (OR: 4.577, 95%CI: 1.553–13.492), hip circumference (OR: 1.093, 95%CI: 1.049–1.138), and marital status (OR: 3.615, 95%CI: 1.228–10.644) were the predominant factors influencing DBP. Conclusions In postmenopausal women, age, BMI, antihypertensive agents, hip circumference, and marital status are associated with SBP changes, while age, alcohol consumption, antihypertensive agents, hip circumference, and marital status with DBP variability. MeSH Keywords postmenopausal women, blood pressure, development track, influencing factors, CHNS

Promoting the well-being of rural elderly people for longevity among different birth generations: A healthy lifestyle perspective.

Wellbeing may have a protective role in health maintenance. However, no specific study clarified the particular protective effect of the subjective wellbeing of rural elderly people on survival probability. Few studies have examined the effect of the lifestyle of rural elderly people on their subjective wellbeing from different perspectives. We investigated whether improving subjective wellbeing increased the probability of longevity of rural elderly people and the effects of lifestyle behaviors on the subjective wellbeing of rural elderly people in different birth generations. Data were derived from the China Health and Nutrition Survey (CHNS), which is an ongoing open cohort study that adopts a multistage, random clustered sampling process. We used the data of elderly people who were aged 65 or over during 2006-2015 for analysis. The Kaplan-Meier method and log-rank test found that the survival probability of rural elderly people was significantly lower than urban elderly people. Based on a sample of rural elderly people, Cox regression and generalized estimating equations were performed as further analyses. A total of 892 rural elderly people aged 65 or over were included in the sample in 2006. High subjective wellbeing was a protective factor against death. The subjective wellbeing of rural elderly people born in the 1940s/1930s/1908-1920s birth generations first decreased then increased. For rural elderly people born in the 1940s, there were significant positive effects of a preference for eating vegetables and walking/Tai Chi on subjective wellbeing. For rural elderly people born in the 1930s, preferences for eating vegetables, reading, and watching TV all had significant positive effects on subjective wellbeing. Rural elderly people born in the 1908-1920s who preferred watching TV had more subjective wellbeing. Improving subjective wellbeing extended the life span and reduced mortality risk in rural elderly people and may be achieved by the shaping of a healthy lifestyle, such as preferences for eating vegetables, walking/Tai Chi, and reading.

Variety and quantity of dietary insoluble fiber intake from different sources and risk of new-onset hypertension

BackgroundThe relations of the variety and quantity of different sources of dietary insoluble fibers and hypertension remain uncertain. We aimed to investigate the associations between the variety and quantity of insoluble fibers intake from six major food sources and new-onset hypertension, using data from the China Health and Nutrition Survey (CHNS).MethodsTwelve thousand one hundred thirty-one participants without hypertension at baseline from CHNS were included. Dietary intake was measured by three consecutive 24-h dietary recalls combined with a household food inventory. The variety score of insoluble fiber sources was defined as the number of insoluble fiber sources consumed at the appropriate level, accounting for both types and quantities of insoluble fibers. The study outcome was new-onset hypertension, defined as blood pressure ≥ 140/90 mmHg, or physician-diagnosed hypertension or receiving antihypertensive treatments during the follow-up.ResultsDuring a median follow-up of 6.1 years, 4252 participants developed hypertension. There were L-shaped associations of dietary insoluble fibers derived from vegetables, beans, tubers, and fruits with new-onset hypertension; a reversed J-shaped association of whole grain-derived insoluble fiber with new-onset hypertension; and no obvious association of refined grain-derived insoluble fiber with new-onset hypertension. Therefore, refined grain was not included in the insoluble fiber variety score calculation. More importantly, a higher insoluble fiber variety score was significantly associated with lower risks of new-onset hypertension (per score increment, hazard ratio, 0.50; 95% CI, 0.45–0.55).ConclusionsThere was an inverse association between the variety of insoluble fibers with appropriate quantity from different food sources and new-onset hypertension.

Associations of parental attitudes and health behaviors with children’s screen time over four years

BackgroundParents are significantly important in shaping the screen use of children within a family system. This study aimed to examine the associations of Chinese children’s screen time (ST) over four years with parents’ attitudes toward their own screen use and physical activities (PA) and health behaviors including their ST, PA, cigarette smoking, and alcohol drinking.MethodsThe current study utilized data from two waves (2011 and 2015) of the China Health and Nutrition Survey (CHNS), including 1,941 mother-father-child triads in 2011 and 2,707 mother-father-child triads in 2015 (with children aged 0-17-years-old). The ST of children and the parental attitudes and health behaviors were measured via self-report or proxy-report (for children under 6 years old) questionnaires. Pool-OLS regression models were used to assess the associations of parental attitudes and health behaviors with the ST of children. Moderation models were built to assess whether these associations depended on the gender, age, and family income of children, as well as whether paternal and maternal influences were moderated by the other parent. A multilevel cross-lagged panel model (CLPM) was used to assess parental influences on children’s ST over four years.ResultsPaternal ST (β = 0.09, p < 0.001), maternal ST (β = 0.10, p < 0.001), and paternal alcohol drinking (β = 0.30, p < 0.05) were positively associated with children’s ST. In addition, maternal smoking had a positive association with girls’ ST (β = 0.53, p < 0.05). Moreover, the association between maternal ST and children’s ST was observed to decline as family income increased (β = -0.03, p < 0.001). Paternal ST had a larger positive association with children’s ST when the ST of mothers exceeded 14 h/week (β = 0.06, p < 0.05). Furthermore, lagged associations were found between paternal attitudes toward PA (β = -1.63, p < 0.05) or maternal cigarette smoking (β = 1.46, p < 0.05) and children’s ST measured four years later.ConclusionChildren establish a healthy lifestyle within the family system. From the perspective of the healthy family climate, the current study suggests that future programs for reducing children’s ST should be built through an integrative approach with special attention to parental attitudes and health behaviors.

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.

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

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