National Nutrition Surveillance Research Articles

Asymptomatic Incidence of Monoclonal Gammopathy of Undetermined Significance and Preclinical Duration to Myeloma Diagnosis: A Modeling Study.

Background Monoclonal gammopathy of undetermined significance (MGUS) is the premalignant condition of multiple myeloma (MM). Given a lack of population-based screening for MGUS and its asymptomatic nature, the epidemiology of MGUS remains unknown. This study estimated age- and race/ethnicity-specific MGUS incidence and preclinical duration from MGUS to MM in the United States. Methods A previously published modeling approach was used to calculate national MGUS incidence using estimates of MGUS prevalence, MM incidence, MM-specific and all-cause mortality, and population age distribution from the National Health and Nutrition Examination Survey, 1999-2004, and Surveillance, Epidemiology, and End Results, 2000-2021. The estimated MGUS prevalence was divided by MGUS incidence to obtain preclinical duration of MM. Results MGUS incidence for non-Hispanic white (NHW) populations was 52, 86, 142, and 181 and for non-Hispanic black (NHB) population was 110, 212, 392, and 570 per 100,000 person-years at ages 50, 60, 70, and 80, respectively. The average preclinical duration was 20.5 (95% confidence interval, CI: 16.5, 26.1) years for the NHW population and 14.2 (95% CI: 11.5, 17.6) years for the NHB population. The cumulative risk of developing MGUS in age 50-85 was 2.8% (95% CI: 1.7%, 4.2%) for the NHW population and 6.1% (95% CI: 3.8%, 10.0%) for the NHB population. Conclusion NHB populations had a higher MGUS incidence rate at all ages and a shorter preclinical duration of MM compared to their NHW counterparts. Impact This study provides insights into the epidemiology of MGUS and enhances our understanding of the natural history of MM.

Association between sedentary behavior, screen time and metabolic syndrome among Chinese children and adolescents

BackgroundThe aim of the study was to investigate the relationship between sedentary behavior, screen time and MetS among Chinese children and adolescents aged 7–17 years. Data was obtained from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017.MethodsData on sedentary time, screen time, and MetS indicators were obtained through physical and health questionnaires, anthropometric measurements, and clinical examinations. MetS was defined according to the Cook’s criteria. Wilcoxon rank sum test and chi-square test were applied for comparisons of measurement data and counting data, respectively. The relationship between sedentary time, screen time, and MetS and its components was analyzed using a multivariate logistic regression model.ResultsThe prevalence of MetS among 7-17-year-old students in 2016–2017 was 5.45%. Compared to those with low sedentary behavior, in high sedentary behavior groups, the prevalence of abdominal obesity, high TG, low HDL-C, and MetS was high in boys, and the prevalence of abdominal obesity, high TG, hyperglycemia, and MetS was high in girls. Moreover, for those who reported ≥ 3 h/day of screen time, the prevalence of abdominal obesity, low HDL-C, and MetS was higher in boys, and the prevalence of abdominal obesity and MetS was higher in girls. After adjusting for confounding variables, the risks of abdominal obesity, high TG, low HDL-C, and MetS were higher in high-level sedentary time group, and the risks of abdominal obesity and MetS were 1.15 and 1.14 times higher for those who spent ≥ 3 h/day on screen time, respectively.ConclusionsThis study shows that high levels of sedentary time and screen time were associated with an increased likelihood of MetS among Chinese children and adolescents aged 7–17 years. Reducing sedentary behavior and screen time may contribute to the prevention of metabolic diseases.

The Relationship between Birth Weight and the Risk of Overweight and Obesity among Chinese Children and Adolescents Aged 7-17 Years.

Obesity is a major public health issue in children and adolescents. Our study aimed to examine the impacts of birth weight on overweight and obesity among Chinese children and adolescents. Using data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017, we included 10,041 participants aged 7-17 years. According to birth weight, participants were categorized into six groups, and the birth weight category of 3000 to 3499 g was chosen as the reference group, containing the largest number of children. Logistic regression analyses were used to investigate the association of birth weight with the risk of being obese at 7 to 17 years of age in multivariable-adjusted models. A restricted cubic spline was utilized to show the odds ratios (ORs) of obesity at different birth weight levels. The adjusted ORs for overweight were 0.98 (95%CI 0.63, 1.53), 1.02 (95%CI 0.84, 1.25), 1.34 (95%CI 1.16, 1.55), 1.72 (95%CI 1.35, 2.18), and 1.17 (95%CI 0.71, 1.96) in several birth weight groups, compared with group C (3000-3499 g). The adjusted ORs for obesity were 0.82 (95%CI 0.48, 1.40), 0.77 (95%CI 0.60, 0.98), 1.33 (95%CI 1.13, 1.57), 1.97 (95%CI 1.53, 2.53), and 2.01 (95%CI 1.27, 3.19). Furthermore, children in the post-pubertal stage had a slightly higher risk of overweight and obesity than those in the pre-pubertal and pubertal stage. Moreover, these associations were stronger among boys. The lower part of normal birth weight range is associated with a lower risk of overweight and obesity in children and adolescents. However, higher levels of birth weight increase risk.

Quality of anthropometric data of children under 5 years in the Brazilian National Food and Nutrition Surveillance System, 2008-2020

The planning, monitoring, and evaluation of food and nutrition actions depend on reliable estimates based on adequate anthropometric data. The study aimed to analyze the quality of anthropometric data of children aged under 5 years in the Brazilian National Food and Nutrition Surveillance System (SISVAN) from 2008 to 2020. The sample comprised 23,453,620 children aged under 5 years. Initially, we evaluated the distribution of missing values and values outside the spectrum of the instrument, and calculated the digit preference index for weight and height. The nutritional indexes height for age (HAZ), weight for age (WAZ), and body mass index for age (BAZ) were calculated according to the World Health Organization 2006 child growth standards. Then, we identified the biologically implausible values (BIV) and calculated the standard deviation (SD) of the nutritional indexes. For each municipality, we calculated the mean and SD of HAZ and WAZ; and plotted the SD values as a function of the mean. In all Federative Units, the digit preference index reached a minimum value of 80 for height and 20 for weight. For the three nutritional indexes, there was a reduction in the frequency of BIV in the 2008-2020 period. Even after the exclusion of BIV, we identified high variability for the three nutritional indexes. The indicators evaluated showed low quality of measurement, especially in the North and Northeast regions. Our results indicate insufficient quality of anthropometric data in children aged under 5 years, and reinforce the need to invest in actions to improve the collection and recording of anthropometric information.

Food and nutrition surveillance actions in Brazil and Portugal: a comparative documentary analysis

Food and nutrition surveillance is fundamental to the formulation, implementation, monitoring, and evaluation of public policies on food and nutrition. The comparative analysis of the evolution of food and nutrition surveillance actions between countries makes it possible to learn about advances, challenges and innovations for the planning of interventions. This study aimed to describe and compare food and nutrition surveillance actions in Brazil and Portugal, countries with different geographical dimensions and socio-economic profiles, but with the common characteristic of having a universal healthcare system. We manually searched for documents describing food and nutrition surveillance actions and for potential data sources on the institutional websites of the Brazilian and Portuguese governments. The recommendations of the READ approach were used (59 documents were identified for Brazil and 29 for Portugal). In Brazil, food and nutrition surveillance actions are included in health policies and in the constraints of conditional cash transfer programs. The Brazilian Households Budget Surveys and health surveys are used simultaneously with the Brazilian National Food and Nutrition Surveillance System (SISVAN). In Portugal, food and nutrition surveillance actions are part of health policies, via the National Program and the Integrated Strategy for the Promotion of Healthy Eating. Among the data sources identified are the Portuguese Food Balance Sheet and household budget, health and food surveys, as well as initiatives to monitor the nutritional status of children and adolescents. In both countries, strategies need to be improved in terms of the regularity of data recording, the harmonization of food consumption indicators and the dissemination of information.

Dietary Habits, Meal Timing, and Meal Frequency in Kuwaiti Adults: Analysis of the Kuwait National Nutrition Surveillance Data.

Dietary habits, including meal frequency, meal timing, and skipping meals, have been extensively studied due to their association with the development of noncommunicable diseases (NCDs). This study describes dietary habits, meal timing, frequency, skipping meals, and late-night eating in Kuwaiti adults. Kuwait National Nutrition Surveillance System data were utilized to reach the objectives of this study. The findings reveal that approximately 54% of the adults in Kuwait eat after 10 p.m., 29% skip breakfast, and 9.8% skip dinner. Furthermore, adults in Kuwait consume 4.4 meals per day on average. Women skip breakfast more often and have more extended night fasting than men (p < 0.001). Married adults skip breakfast and dinner less than unmarried adults (p < 0.001). In conclusion, this descriptive study provides valuable insights into the dietary habits of Kuwaiti adults, emphasizing the importance of further investigating the association between meal timing, meal frequency, and the prevalence of NCDs in Kuwait.

Energy and macronutrients intake of the elderly aged 75 years and above in China in 2015

To analyze the intake of energy and macronutrients in the elderly aged 75 years and above in China. The data was sourced from the China National Chronic Non-communicable Disease and Nutrition Surveillance, which adopted a multi-stage stratified clustered random sampling method and selected 298 monitoring points from 31 provinces across the country to carry out chronic non-communicable disease and nutrition surveillance of Chinese adults. The condiments weighting method and 3-day 24-hour dietary review method were used to collect dietary data for residents. Based on the dietary survey result of 3368 elderly people aged 75 years and above in the surveillance, the intake of energy and macro nutrients of elderly people was analyzed. Among the elderly aged 75 years and above included in the analysis, there were 1727 males and 1641 females, 1511 people in urban areas and 1857 people in rural areas, 1956 people aged 75-79, 1412 people aged ≥ 80. The average energy intake of the elderly aged 75 years and above in China was(1601.0±473.4)kcal, and the average intakes of carbohydrate, protein and fat were(219.6±76.6)g, (48.2±18.6)g and(60.2±31.5)g, respectively. The energy supply ratios of carbohydrate, protein and fat were 54.9%, 12.0% and 33.1% respectively. The carbohydrate intake and its energy supply ratio of the urban elderly((200.0±74.0)g and 51.8%) were significantly lower than those of the rural elderly((235.5±75.0) and 57.4%), while the protein intake and its energy supply ratio((50.2±18.9)g and 13.0%), fat intake and its energy supply ratio((61.2±30.2)g and 35.2%)of the urban elderly were significantly higher than those of the rural elderly((46.5±18.2)g and 11.2% for protein, and(59.4±32.5)g and 31.4% for fat). According to Chinese dietary reference intake standard, only 28.1% of the elderly aged 75 and above reached the recommended value of energy, 71.9% of the elderly did not take enough energy, the proportion of insufficient protein intake was 72.2%, 68.5% in urban areas and 75.2% in rural areas, the proportion of people with fat to energy ratio more than 30% was 58.5%, 65.3% in urban areas and 52.9% in rural areas. The energy intake of the elderly aged 75 years and above in China was insufficient, the protein intake was low, the fat to energy ratio was too high, and the dietary structure was unreasonable.

Qualitative Review of National Nutrition Surveillance Systems in the Eastern Mediterranean Region.

This study focused on the functional nutrition surveillance systems in eight Arab countries; namely Kuwait, Morocco, Oman, Palestine, Saudi Arabia, Sudan, Syria, and Yemen. The study's analysis involved utilizing primary data collected from both published and unpublished reports. Additionally, a structured checklist was employed to gather information from all countries involved in the study. Furthermore, interviews were conducted with the EMRO offices to gain deeper insights into the challenges, if any, that these nutrition surveillance systems face in functioning optimally. All countries use health facilities as a basic source of data for their nutrition surveillance, some countries triangulate their nutrition surveillance reports with data from other sources of information such as community or school surveys. Identified nutrition surveillance approaches are closely split between those who operate in stable settings and use routine health information systems (Morocco, Saudi Arabia, Oman, and Kuwait) and other countries that operate in fragile settings; for example, Yemen, Syria, Palestine, and Sudan struggle to provide early warning reports for rapid nutritional responses. Nutrition surveillance systems that utilize existing health information systems are the most sustained in the EMRO region. However, by integrating data from multiple sources, such as health facilities, surveys, and population censuses, countries can provide a holistic view of the nutritional situation, enhance their response to any emergency, and can leverage the infrastructure and resources already in place for health data collection and reporting. Collaboration between countries in the region through sharing experiences and success stories is important in order to reach a standardized system that can be implemented in different settings.

Considerable decreased fruits and snack consumption in Iran population during COVID-19 lockdown: a cross-sectional web-based survey National Food and Nutrition Surveillance

BackgroundInadequate fruits and vegetables intake is associated with several diseases. This study aimed to explore changes in fruits and snack consumption during the COVID-19-related lockdown in Iran.MethodsAn online cross-sectional survey among Iranian households was conducted from the 4th to 25th April 2020, during the COVID-19 lockdown. Data were collected about any changes in frequency consumption of the fruits and snacks and the reasons for the changes. Ordinal logistic regression was performed to examine which factors contributed to changes in consumption. To account for the complex sampling design and allow inferences valid for the population, sampling weights were used in all analyses.ResultsA total of 21,290 households took part in the survey. During the epidemic, consumption of fruits and snacks decreased by 35% and 44%, respectively. Among the households whose fruit intake was decreased, about 21% fully omitted it from their food baskets. Residing in rural areas, having more than six members in the household, income loss, and residing in deprived provinces were directly associated with decreased consumption of fruits and snacks. Being a female-headed household was positively associated, and having persons with COVID-19 in the households was inversely associated, with decreased consumption of fruits. The main reason for reducing fruit and snack consumption was income loss.ConclusionsA significant decline in fruit and snack consumption because of COVID-19 lockdown was seen among the Iranian households. It is likely that these changes in dietary habits will become longstanding with consequent adverse health outcomes.

Screen time among Chinese primary and middle school students from 2016 to 2017

To get a better knowledge of the current situation of screen time among primary and secondary school students in all provinces of China from 2016 to 2017. Data was from the China National Nutrition and Health Surveillance of Children and Lactating Women(2016-2017).275 monitoring points were selected from 31 provinces of China by multi-stage stratified cluster random sampling. A total of 280 primary and secondary school students from 2 primary schools, 2 junior middle schools and 1 senior high school were randomly selected from each monitoring point to complete the survey.73629 primary and secondary school students(except grade 9 and grade 12) were included in this study. From 2016 to 2017, the average daily screen time of Chinese primary and secondary school students was(1.65±1.54) hours, M(P25, P75) was 1.29(0.58, 2.21) h. In terms of provinces, the average daily electronic screen time of primary and secondary school students in Beijing, Tianjin, Jilin, Fujian, Guangdong and Hainan is more than 2 hours. In terms of rural and urban areas, the screen time of students in Beijing&apos;s rural and urban areas, Tianjin&apos;s rural areas, Hebei&apos;s urban areas, Liaoning&apos;s rural areas, Jilin&apos;s rural areas, Fujian&apos;s urban areas, Guangdong&apos;s urban areas, Guangxi&apos;s urban areas, Hainan&apos;s rural and urban areas, and Xinjiang&apos;s urban areas all exceeds 2 hours/day. Besides, screen times of rural primary and secondary school students in Beijing(Z=2.62, P&lt;0.01), Tianjin(Z=5.94, P&lt;0.01), Liaoning(Z=11.56, P&lt;0.01), Jilin(Z=-7.59, P&lt;0.01), Shanghai(Z=3.19, P&lt;0.01), Jiangsu(Z=12.00, P&lt;0.01), Zhejiang(Z=-4.80, P&lt;0.01), Anhui(Z=-4.67, P&lt;0.01), Jiangxi(Z=-3.29, P=0.01), and Sichuan(Z=-4.53, P&lt;0.01) are longer than that of urban students. There are urban-rural differences in the average daily electronic screen time and different types of electronic screen time of primary and secondary school students in China&apos;s provinces from 2016 to 2017.

Dietary Supplement Use among Iranian Households during COVID-19 Epidemic Lockdown: Less Access in Those Who May Need More National Food and Nutrition Surveillance.

The coronavirus disease 2019 (COVID-19) pandemic elicited the general population to use various dietary supplements (DSs) and nutraceuticals as a protective means against the disease. The present study aimed to evaluate changes and certain determinants of DS intake during the COVID-19 lockdown among Iranian households. This nationwide cross-sectional study was conducted from April 4 to April 25, 2020, during which Iran was in lockdown. To collect data, a web-based electronic self-administered questionnaire was created. The data were compared among provinces based on their food security situations. A total of 21,290 households were included in the analyses. Approximately 27% of the households were using DSs after the epidemic. The most common DSs used were vitamin D (42%) and vitamin C (20%), followed by multi-vitamin (16%), zinc (9%), omega-3 (6%), vitamin A (4%), and probiotics (3%). Logistic regression analysis revealed that DS intake was directly associated with the household income but inversely with household size and the food security status of the provinces. DS intake was positively associated with the presence of high-risk persons in the households, the education of the households' head, and the presence of a person with a history of COVID-19 within the household. During epidemic lockdown, DS use was remarkably increased among the Iranian households. Apart from the debatable usefulness of DSs against COVID-19, the inverse association of DS use with a household's income and provincial food security well indicates inequity in accessibility to DS. Actions to improve the nutritional status of the under-privileged populations including targeted supplementation are strongly recommended.

Nutrient Patterns and Its Association and Metabolic Syndrome among Chinese Children and Adolescents Aged 7–17

This study was designed to explore the associations between nutrient patterns (NPs) and metabolic syndrome (MetS) and its five components among Chinese children and adolescents aged 7-17. The required data of participants were collected from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017. Ultimately, 13,071 participants were included. Nutrient patterns were obtained by means of factor analysis. Multivariate logistic regression analysis was conducted to evaluate the association between nutrient patterns with MetS and its components. After adjusting covariates, the results of logistic regression models revealed that high-carbohydrate patterns were associated with the presence of abdominal obesity. The high-animal protein pattern was negatively associated with high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C). The high-sodium-and-fat pattern had a negative relationship with elevated blood pressure (BP) and was positively associated with low HDL-C. The high-Vitamin D-and-Vitamin B12 pattern had protective effects on MetS, high TG, and low HDL-C. Further large-scale longitudinal investigations are necessary in the future.

Circulating 25-hydroxyvitamin D is associated with metabolic phenotypes of obesity: National Food and Nutrition Surveillance

Different phenotypes of obesity are each related with different complications and comorbidities. We hypothesized that suboptimal vitamin D status is directly associated with an unhealthy metabolic status, especially if allied with obesity. This cross-sectional study was performed in the framework of the National Food and Nutrition Surveillance. Overall, 1098 men and women participated in this study. In addition to height and weight, serum concentrations of 25-hydroxyvitamin D (25(OH)D) and glycemic and lipidemic status were evaluated. Then participants were classified into 4 groups based on body mass index and lipidemic and glycemic profile status, as follows: hyperglycemic-dyslipidemic obese (HDO), hyperglycemic-dyslipidemic nonobese (HDNO), normoglycemic-normolipidemic obese (NNO), and normoglycemic-normolipidemic nonobese (NNNO). In this study, 31.6% of participants were classified as HDO, 7.5% as HDNO, 34.5% as NNO, and 26.4% as NNNO. The frequency of suboptimal vitamin D status was more prevalent in HDO (81.8%) than in other phenotypes (HDNO, 80%; NNO, 77.6%; NNNO, 73.8%; P = .015). In the multivariate model, suboptimal vitamin D status significantly increased the odds of being NNO (odds ratio [OR], 1.28; 95% CI, 0.84-1.95), HDNO (OR, 1.48; 95% CI, 0.77-2.83), and HDO (OR, 1.73; 95% CI, 1.11-2.7) compared with the NNNO group. Likewise, in multivariate model, per each unit (ng/mL) increment in 25(OH)D concentration, the odds of HDNO and HDO decreased significantly by 4% (OR, 0.96; 95% CI, 0.94-0.98) and 7% (OR, 0.93; 95% CI, 0.92-0.95), respectively. The results of the study showed a significant relationship between serum 25(OH)D concentrations and metabolic obesity phenotypes; these data confirm the association between suboptimal vitamin D status and metabolic complications, especially in obese individuals.

COVID-19 epidemic lockdown-induced remarkable decrease in dairy products consumption of Iran population: does it really matter? National Food and Nutrition Surveillance

BackgroundThe pandemic of the newly emerged coronavirus infection and its related disease, Covid-19, has influenced various aspects of human life including dietary habits. This study aimed to examine changes in dairy products consumption during Covid-19 lockdown period in a huge sample of Iranian households.MethodsA cross-sectional descriptive-analytical study using a web-based electronic self-administered questionnaire designed to detect any changes in the consumption frequency of dairy products in the Iranian households during Covid-19 lockdown.ResultsA total of 21,290 households were enrolled. During Covid-19 epidemic lockdown, about 29%, 26% and 7% of the households had decreased their consumption frequency of milk, yogurt and cheese, respectively. The female-headed households were 21% more likely to decrease their consumption of milk, compared with male-headed households (OR = 1.21, 95% CI: 1.05–1.4). The households residing in food insecure provinces were 29%, 20% and 45% more likely to decrease their consumption of milk, yogurt and cheese as compared with those living in the food secure provinces. About 37%, 25.3%, 19.4% of those households who reported a decrease in consumption of dairy products had fully omitted them.ConclusionWe found considerable decrement of dairy products consumption, especially milk and yogurt, in a high proportion of the studied households. Inadequate intake and, in some households, omission of dairy products can potentially bring about serious health outcomes with heavier economic burden. Further studies to track these changes over time and to evaluate their health consequences are warranted.

Association of Dietary Patterns with Metabolic Syndrome in Chinese Children and Adolescents Aged 7-17: The China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017.

This study aims to determine the associations of dietary patterns with metabolic syndrome (MetS) and its components in Chinese children and adolescents aged 7–17 in 2016–2017. Using the data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, the sociodemographic information, diet, anthropometric measurements and clinical examinations of subjects were obtained, and a total of 13,071 school-aged children and adolescents were included in this study. The Cook criteria were used to define MetS and its components. Dietary intake was derived from 24-h dietary records for three consecutive days, combined with the weighing method. Factor analysis was used to identify major dietary patterns. The associations of dietary patterns with MetS and its components were examined by logistic regression analysis. Consequently, five distinct dietary patterns were identified by factor analysis, and the relationships between dietary patterns with MetS and its components were observed. After adjusting for covariates, the animal product and vegetable patterns may have a positive association with MetS; the condiment pattern was positively associated with low HDL-C; the fruit and junk food patterns had positive relationships with MetS, abdominal obesity and high TG; the cereals and tubers pattern was positively associated with MetS, abdominal obesity, high TG and low HDL-C; the beans pattern was positively associated with high TG.

Association Between Gestational Weight Gain in Each Trimester and Weight Retention at 6 and 12 Months Postpartum: Results From a National Administrative Dataset in Brazil

ObjectivesTo estimate the association between gestational weight gain (GWG) in the first, second, and third pregnancy trimesters and weight retention at 6 and 12 mo postpartum.MethodsIndividual data from the Brazilian National Food and Nutrition Surveillance System from 2008–2020 were used. Cumulative GWG was calculated as the difference between the last weight measured in each trimester and self-reported pre-pregnancy weight, standardized for gestational age and pre-pregnancy body mass index (BMI) into z-scores using the Brazilian charts. Postpartum weight retention (PWR) was calculated as the difference between weight measured close to (±1 month) 6 and 12 months postpartum and self-reported pre-pregnancy weight and categorized as < 5 or ≥ 5 kg. Median, interquartile ranges (IQR), frequencies, and proportions were calculated. Maternal age (y), participation in the Bolsa Familia conditional cash transfer program (yes/no), and pre-pregnancy BMI (kg/m2) were used to adjust linear regression models.ResultsAmong the 31,846 women included, 88.5% were < 35 y old; 77.2% participated in the Bolsa Familia program, and 52.7% were classified as normal weight before pregnancy. The median (IQR) cumulative GWG was 1.2 (0–2.8), 4.0 (1.2–7.0), and 9.0 (5.3–12.7) kg in the first, second, and third pregnancy trimesters, respectively. At 6 and 12 mo postpartum, 32.7% and 31.4% of the women had PWR ≥ 5 kg, respectively. The prevalence of PWR ≥ 5 kg at 6 and 12 mo was higher among women who gained weight > 90th percentile of the Brazilian charts than those who gained below those values (73.2 v. 29.6% for 6; 63.9 v. 28.7% for 12 mo, respectively). Each 1 z-score increase in the cumulative GWG in the first, second, and third trimesters was associated with an increase of 2.0, 2.3, and 2.4 kg, respectively, in the PWR at 6 mo. Similar trends were observed for PWR at 12 mo (P < 0.001 for all cases).ConclusionsGWG in all pregnancy trimesters was associated with PWR at 6 and 12 mo postpartum. The association between GWG in the first trimester and PWR highlights the importance of monitoring weight gain since the beginning of pregnancy to prevent the occurrence of adverse outcomes, such as maternal obesity, during the postpartum period.Funding SourcesBill & Melinda Gates Foundation.

The Association of Sleep Duration with Breakfast Patterns and Snack Behaviors among Chinese Children Aged 6 to 17 Years: Chinese National Nutrition and Health Surveillance 2010-2012.

A significant increase in the prevalence of short sleep among children has been observed. Short sleep may be associated with unhealthy breakfast and snacking behaviors. The purpose of the current study was to explore the associations of short sleep with breakfast and snacking behaviors among children. Data were obtained from the 2010–2012 China National Nutrition and Health Surveillance (CNNHS). A total of 5254 children aged 6 to 17 years were included. Sleep duration was classified into three categories: moderate sleep, slightly short sleep, and severely short sleep. Breakfast behaviors included skipping breakfast, food diversity, intake of energy and macronutrients, and their proportion of daily total intake. Snack behaviors included snack consumption rate/frequency, types, intake of energy and macronutrients, and proportion of daily total intake. Multiple linear regression and multivariate logistic regression were used for analysis, with models adjusted for the potential effects of gender, age, region, and family income level. The bootstrapping method was used to calculate the 95% confidence intervals of the model statistics. Results showed that slightly short sleep (OR = 1.15, 95%CI: 1.00, 1.33)) and severely short sleep (OR = 1.36, 95%CI: 1.04, 1.77) was related to higher rates of skipping breakfast compared to moderate sleep. Severely short sleep was associated with higher energy (β = 28.44, 95%CI: 31.97, 44.70), carbohydrate (β = 6.62, 95%CI: 8.29, 8.84) and protein (β = 1.17, 95%CI: 1.44, 1.70) intake at breakfast and breakfast accounted for a higher proportion of total daily energy (β = 1.39, 95%CI: 1.48, 2.52), protein (β = 2.26, 95%CI: 3.16, 5.84) and carbohydrate (β = 0.83, 95%CI: 0.07, 3.41). Severely short sleep was associated with higher energy (β = 27.4, 95%CI: 18.64, 69.41), protein (β = 0.8, 95%CI: 0.48, 2.40), and fat (β = 1.40, 95%CI: 1.21, 3.16) intake at snacks and snacks accounted for a higher proportion of total daily protein intake (β = 1.23, 95%CI: 0.71, 3.58) and fat intake (β = 2.74, 95%CI: 3.13, 6.09). Slightly short sleep was associated with higher energy (β = 7.28, 95%CI: 0.15, 28.13) and carbohydrate (β = 1.67, 95%CI: 0.86, 5.73) intake at snacks and snacks accounted for a higher proportion of total daily carbohydrate intake. Children with severely short sleep were more likely to choose sugar-sweetened beverages (SSBs) as snacks (16.5%) and intake them more frequently, at a daily consumption of 204.7 g and 26.7 g per night. Overall, short sleep was associated with unhealthy breakfast patterns and snack behaviors among children. Children with short sleep had higher intake of energy and macronutrients at breakfast and snacks compared with those with moderate sleep. Promoting adequate sleep among children may have a positive effect on developing healthy eating behaviors.

Gestational weight gain and associated factors of Chinese women in the second and third trimester of pregnancy in 2015

To describe gestational weight gain status of pregnant women in China, and to explore potential factors related to gestational weight gain of pregnant women in the 2 nd and 3 rd trimester in 2015. Participants were from Chinese National Nutrition and Health Surveillance in 2012 and in 2015. Using a multi-stage stratified cluster random sampling method, a total of 8512 pregnant women were recruited in 2015. A standard questionnaire was used to collect general information and pre-pregnancy weight. Body weight and height of pregnant women were measured using a unified weighing scale and stadiometer. In 2015, the prevalences of underweight, normal weight, overweight and obesity in pre-pregnancy were 16.0%, 66.0%, 14.9%, 3.1% according to Chinese BMI standard, respectively. In the 2 nd trimester, the prevalences of inadequate gestational weight gain, appropriate gestational weight gain and excess gestational weight gain were 14.6%, 27.2% and 58.2% based on IOM gestational weight gain standard, respectively. In the 3 rd trimester, the prevalences of inadequate gestational weight gain, appropriate gestational weight gain and excess gestational weight gain were 12.7%, 31.5%, 55.8% based on IOM gestational weight gain standard, respectively. The odds of excess gestational weight gain was 1.53(95%CI 1.19-1.99) in the second trimester, and 2.05(95% CI 1.59-2.63) in the third trimester for overweight women, compared to normal weight women during pre-pregnancy. The prevalence of excess gestational weight gain showed an increasing trend in both urban and rural areas, which was not related to pregnant women&apos;s age and education. Second parity might be a protective factor for appropriate weight gain in late pregnancy. Compared to 2012, the prevalence of underweight before pregnancy and inadequate gestaional weight gain decreased in 2015. By contrast, the prevalence of overweight, obesity and excess gestational weight gain showed an upward trend.

Stroke Risk Factors of Stroke Patients in China: A Nationwide Community-Based Cross-Sectional Study.

Background: Stroke is the leading cause of death in China, and its burdens are rapidly increasing. The prevalence and control of stroke risk factors among stroke patients in China are unknown. Objective: We investigated the stroke risk factors of stroke patients in China. Design: We examined stroke risk factors in 6580 stroke patients aged 18 years or older in the China National Chronic Diseases and Nutrition Surveillance of Adults (2015–2017). With regard to the basic characteristics of the study participants, categorical variables were described as frequency (percent). The chi-square test was used to analyze the difference between men and women. The multivariate logistic regression model was used in the multivariate analysis. Results: Among the 6580 stroke patients, hypertension was the most common stroke risk factor identified in most cases (78.51%), followed by overweight or obesity (61.58%), dyslipidemia (54.38%), smoking (24.04%), diabetes (21.75%), family history of stroke (17.43%), lack of exercise (16.35%), and atrial fibrillation (4.47%). Drinking stroke patients had a lower rate of hypertension, diabetes, and dyslipidemia. Patients with hyperuricemia had a higher rate of hypertension and dyslipidemia than no-hyperuricemia patients. The hypertension awareness, treatment, and control rates among hypertension stroke patients were 73.62%, 70.19%, and 17.79%, respectively. The diabetes awareness, treatment, and control rates among diabetes patients were 69.74%, 65.83%, and 34.59%, respectively. The dyslipidemia awareness, treatment, and control rates among dyslipidemia patients were 42.37%, 29.4%, and 20.07%, respectively. Among treated hypertension patients, the rates of taking medicine as medically advised, controlled diet, increased exercise, and blood pressure monitoring were 91.31%, 58.88%, 45.78%, and 73.99%, respectively. Among treated diabetes patients, the rates of oral antidiabetic medications, insulin injection, diet control, and blood glucose monitoring were 78.24%, 34.71%, 85.77%, and 78.24%, respectively. Among treated dyslipidemic patients, the rate of taking medicine as medical advice, controlled diet, increased exercise, and regular blood lipid monitoring was 80.61%, 77.57%, 56.46%, and 40.3%, respectively. Conclusions: The most common risk factors for community stroke patients in China are hypertension, dyslipidemia, and overweight or obesity. The stroke community patients’ suboptimal awareness and treatment of hypertension, and suboptimal awareness, treatment, and control of diabetes, and dyslipidemia are significant problems in China.

Prevalence of Infant and Young Child Feeding Practices and Differences in Estimates of Minimum Dietary Diversity Using 2008 and 2021 Definitions: Evidence from Bangladesh

ABSTRACTBackgroundInfant and young child feeding (IYCF) practices directly impact the health of <2-y-old children. Minimum dietary diversity (MDD) is an IYCF indicator to assess feeding practices of children aged 6–23 mo. The definition of MDD has recently been updated by the WHO and UNICEF, substituting “≥4 out of 7 food groups” (MDD-7FG) with “≥5 out of 8 food groups” (MDD-8FG).ObjectivesThe goals of this study were to estimate the prevalence of IYCF indicators and identify the implications of the change in the prevalence of MDD at the national and regional levels of Bangladesh.MethodsThis study used data from the National Food Security and Nutrition Surveillance 2018–2019 round. A total of 1992 children aged 0–23 mo were included in this analysis. IYCF indicators and MDD were calculated according to the WHO-UNICEF guidelines. The difference between the prevalence of MDD-7FG and MDD-8FG is presented as percentage points.ResultsThe prevalence of early initiation of breastfeeding was 43.8%, and exclusive breastfeeding was 56.2%. Approximately 55% of children maintained MDD (MDD-7FG), 48% received minimum meal frequency, and 28% received a minimum acceptable diet. Compared with MDD-7FG, the prevalence of MDD-8FG was lower among 6–23-mo-old children. The difference between MDD prevalence (MDD-8FG vs. MDD-7FG) was high for boys (44.0% vs. 53.2%), children aged 12–23 mo (53.4% vs. 63.4%), in urban areas (30.2% vs. 42.4%), in the Dhaka administrative division (42.0% vs. 56.3%), among uneducated mothers (37.1% vs. 47.1%), in households with ≤4 members (44.3% vs. 55%), and for middle-class households (40.3% vs. 57.6%).ConclusionsThe new method led to a decrease in the prevalence of MDD in Bangladesh. As the country prepares to implement the new indicator, it is critical to disseminate the new knowledge and its positive implication for improved child feeding and nutrition.