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Despite observed ethnic differences in eating patterns and obesity, evidence in China is limited. This study examined ethnic differences in eating patterns and their associations with weight outcomes among multi-ethnic adults in West China. A cross-sectional survey collected self-reported data on demographics, eating behaviours, weight and height in 2021. Principal component analysis and multivariate regression were conducted to identify eating patterns and examine their associations with weight outcomes. In total, 4407 subjects aged ≥ 18 years were recruited across seven provinces in West China. Four eating patterns were identified: ‘meat-lover’ – characterised by frequent consumption of meat and dairy products, ‘indulgent’ – by frequent intakes of added salt, sugar, alcohol and pickled food, ‘diversified-eating’ – by frequently consuming food with diversified cooking methods and eating out and ‘nutri-health-concerned’ – by good food hygiene behaviours and reading food labels. Ethnic differences in eating patterns were observed. Compared with Han, Hui were less likely to exhibit meat-lover or diversified-eating patterns; Tibetans were less likely to have meat-lover or nutri-health-concerned patterns; Mongolians were more likely to have indulgent pattern. BMI was positively associated with meat-lover pattern in both genders (exp(β): 1·029; 95 % CI: 1·001, 1·058 for men; 1·018; 1·000, 1·036 for women) and negatively associated with nutri-health-concerned pattern in women (0·983; 0·966, 1·000). Mongolians were two times more likely to be overweight/obese than Han (OR: 3·126; 1·688, 5·790). Considerable ethnic differences existed in eating patterns in West China. Mongolians were more likely to be overweight/obese, which was associated with their indulgent eating patterns. Ethnic-specific healthy eating intervention programs are needed.
We assessed longitudinal association between calcium intake during adolescence and hypertension in adulthood. Longitudinal study data of 1611 participants from the China Health and Nutrition Survey during 1991–2011 were used. On average they were followed for 11·4 years. Dietary calcium intake during adolescence was assessed based on three 24-hour dietary recalls collected in each visit/survey between 1991 and 2009 (seven waves). The intake was recoded into quartiles. Cumulative mean±SD calcium intake was 199·9±144·8 mg/1000 kcal/day during adolescence. In total 102 participants had hypertension in adulthood (97 men and 5 women). There was a clear U-shaped association between adolescence calcium intake quartiles and adulthood hypertension: across the quartiles, hypertension prevalence was 6·7%, 4·0%, 5·2% and 9·5%, respectively. After adjustment for potential confounders including weight status and dietary pattern, odds ratios (OR, 95% CI) for hypertension were 2·32 (95% CI 1·07–5·00) for lowest quartile, 1·00 (reference), 1·34 (95% CI 0·61–2·97), and 3·10 (95% CI 1·49–6·46) across the quartiles. Lower or higher calcium intake during adolescence was associated with hypertension in adulthood independent of weight status and dietary pattern.
Examine mother–son, mother–daughter, father–son and father–daughter resemblance in weight status, and potential modifying effects of socio-demographic and childcare characteristics.
1973 school-age children and their parents from five mega-cities across China in 2017.
Pearson correlation coefficients (r) for BMI of father–son, father–daughter, mother–son and mother–daughter pairs were 0·16, 0·24, 0·26 and 0·24, respectively, while their weighted kappa coefficients (k) were 0·09, 0·14, 0·04 and 0·15, respectively. Children aged 6–9 years (r ranged from 0·30 to 0·35) had larger BMI correlation with their parents than their counterparts aged 10–14 years or 15–17 years (r ranged from 0·15 to 0·24). Children residing at home (r ranged from 0·17 to 0·27) had greater BMI correlations with their parents than children residing at school/other places. BMI correlation coefficients were significant if children were mainly cared for by their mothers (r ranged from 0·17 to 0·29) but non-significant if they were mainly cared for by others. Only children who ate the same meal as their parents ‘most times’ (r ranged from 0·17 to 0·27) or had dinner with their parents ‘at most times’ (r ranged from 0·21 to 0·27) had significant BMI correlation with their parents. Similarly, children who had dinner with their parents ‘most times’ but not ‘sometimes,’ had significant BMI correlation coefficients.
Parent–child resemblance in weight status was modest and varied by child age, gender, primary caregiver, whether having similar food or dinner with parents in China.
Previous studies in China showed large sex differences in childhood overweight and obesity (OW/OB) rates. However, limited research has examined the cause of these sex differences. The present study aimed to examine individual and parental/familial factors associated with sex differences in childhood OW/OB rates in China.
Variables associated with child weight status, beliefs and behaviours, and obesity-related parenting practices were selected to examine their sex differences and association with a sex difference in child OW/OB outcomes using logistic regression analysis.
Cross-sectional data analysis using the 2011 China Health and Nutrition Survey.
Children aged 6–17 years (n 1544) and their parents.
Overall child OW/OB prevalence was 16·8 %. Adolescent boys (AB; 12–17 years) were about twice as likely to be overweight/obese as adolescent girls (AG; 15·5 v. 8·4 %, P<0·05). AB more likely had energy intake exceeding recommendations, self-perceived underweight, underestimated their body weight and were satisfied with their physical activity level than AG. AG more likely practised weight-loss management through diet and self-perceived overweight than AB. Mothers more likely identified AG’s weight accurately but underestimated AB’s weight. Stronger associations with risk of childhood OW/OB were found in boys than girls in dieting to lose weight (OR=6·7 in boys v. 2·6 in girls) and combined maternal and child perception of the child’s overweight (OR=35·4 in boys v. 14·2 in girls).
Large sex differences in childhood obesity may be related to the sex disparities in weight-related beliefs and behaviours among children and their parents in China.
Childhood obesity has increased rapidly in China, but understanding is limited on how parents perceive their child’s weight status and how this perception affects weight-related parenting practices. We examined maternal perception of her child’s weight status and its association with demographics, subsequent weight-related parenting practices, the child’s health behaviours and weight change.
Maternal perception of child’s weight status and health behaviours from the China Health and Nutrition Surveys were assessed at baseline and in follow-up surveys for 816 children aged 6–18 years during 2004–2011. Associations were tested using mixed models.
Overall, maternal and child perceptions of the child’s weight status were fairly consistent (κw=0·56), 63·8 % of mothers had correct perception. While 9·6 % of mothers perceived their child as overweight, 10·9 % of children did so, and 13·6 % of children were indeed overweight. Compared with mothers who viewed their children as normal weight, mothers who thought their children were overweight were more likely to encourage their children to increase their physical activity (OR; 95 % CI: 1·8; 1·0, 3·3) and to diet (4·3; 2·3, 7·8). Children perceived as overweight by their mothers were more likely to have insufficient physical activity (2·8; 1·6, 4·7) and gain more weight during follow-up (BMI Z-score, β (se): 1·0 (0·1); P<0·01) than children perceived by their mothers as normal weight.
In China, mothers who perceive their child as overweight are more likely to encourage their child to exercise and modify their diet for weight management, but this encouragement does not seem to improve the child’s health behaviours and weight status.
Dietary fat intake is correlated with increased insulin resistance (IR). However, it is unknown whether gene–diet interaction modulates the association. This study estimated heritability of IR measures and the related genetic correlations with fat intake, and tested whether dietary fat intake modifies the genetic influence on type 2 diabetes (T2D)-related traits in Chinese child twins. We included 622 twins aged 7–15 years (n 311 pairs, 162 monozygotic (MZ), 149 dizygotic (DZ)) from south-eastern China. Dietary factors were measured using FFQ. Structural equation models were fit using Mx statistical package. The intra-class correlation coefficients for all traits related to T2D were higher for MZ twins than for DZ twins. Dietary fat and fasting serum insulin (additive genetic correlation (rA) 0·20; 95 % CI 0·08, 0·43), glucose (rA 0·12; 95 % CI 0·01, 0·40), homoeostasis model of assessment-insulin resistance (Homa-IR) (rA 0·22; 95 % CI 0·10, 0·50) and the quantitative insulin sensitivity check index (Quicki) (rA −0·22; 95 % CI −0·40, 0·04) showed strong genetic correlations. Heritabilities of dietary fat intake, fasting glucose and insulin were estimated to be 52, 70 and 70 %, respectively. More than 70 % of the phenotypic correlations between dietary fat and insulin, glucose, Homa-IR and the Quicki index appeared to be mediated by shared genetic influence. Dietary fat significantly modified additive genetic effects on these quantitative traits associated with T2D. Analysis of Chinese twins yielded high estimates of heritability of dietary fat intake and IR. Genetic factors appear to contribute to a high proportion of the variance for both insulin sensitivity and IR. Dietary fat intake modifies the genetic influence on blood levels of insulin and glucose, Homa-IR and the Quicki index.
Background: Despite evidence for some genetic control of dietary intake in adults, there is little evidence of how genetic factors influence children's dietary patterns. Objective: To estimate heritability of dietary intake in twin children from China and test if genetic effects on dietary intakes vary by the children's socio-economic status (SES). Methods: A sample of 622 twins (162 monozygotic and 149 dizygotic pairs; 298 boys and 324 girls aged 7–15 years) was recruited in South China. Dietary intakes were assessed using a validated 145-item semi-quantitative food frequency questionnaire. Pooled and sex-specific dietary patterns were identified using factor analysis. Heritability was estimated using structural equation models. Results: Heritable components differed by gender and for nutrients and food groups; and estimated heritability of dietary patterns was generally greater in girls than boys. In boys, estimated heritabilities ranged from 18.8% (zinc) to 58.4% (fat) for nutrients; and for food group, 1.1% (Western fast foods) to 65.8% (soft drinks). In girls, these estimates ranged from 5.1% (total energy) to 38.7% (percentage of energy from fat) for nutrients, and 12.6% (eggs) to 94.6% (Western fast foods) for food groups. Factor analysis identified five food patterns: vegetables and fruits, fried and fast foods, beverages, snacks and meats. Maternal education and family income were positively associated with higher heritabilities for intake of meat, fried, and fast food. Conclusions: Genetic influence on dietary intakes differed by gender, nutrients, food groups, and dietary patterns among Chinese twins. Parental SES characteristics modified the estimated genetic influence.
In the present study, we evaluated the reproducibility and validity of dietary patterns among Chinese adult populations. A random subsample of 203 participants (aged 31–80 years) from a community-based nutrition and health survey was enrolled. An eighty-seven-item FFQ was administered twice (FFQ1 and FFQ2) 1 year apart; four 3 consecutive day, 24-h dietary recalls (24-HDR, as a reference method) were performed between the administrations of the two FFQ every 3 months. Dietary patterns from three separate dietary sources were derived using factor analysis based on twenty-eight predefined food groups. Comparisons between dietary pattern scores were made by using Pearson’s or intraclass correlation coefficients (ICC), cross-classification analysis, weighted κ statistic and Bland–Altman plots; the four major dietary patterns identified from FFQ1, FFQ2 and 24-HDR were similar. Regarding reproducibility, ICC for z-scores between FFQ1 and FFQ2 were all >0·6 for dietary patterns. The ‘animal and plant protein’ pattern had the highest ICC of 0·870. For validity, the adjusted Pearson’s correlation coefficients for dietary pattern z-scores between two FFQ and the mean of four 3 consecutive day 24-HDR ranged from 0·387 for the ‘Chinese traditional’ pattern to 0·838 for the ‘animal and plant protein’ pattern. More than 75 % of the participants were classified into the same or adjacent quartile, and <5 % were misclassified into opposite quartiles. The weighted κ ranged from 0·259 to 0·680. Bland–Altman plots indicated that no significant deviation was found between two dietary assessment methods. Our findings indicate a good reasonable reproducibility and a reasonable validity of dietary patterns derived by factor analysis in China.
Dietary patterns represent the combined effects of foods, and illustrate efficaciously the impact of diet on health outcomes. Some findings of previous studies have limited applicability to Chinese children due to cultural factors. The presnt study was designed to identify dietary patterns and determine their relationships with obesity among Chinese children and adolescents. Data collected from 1282 children and adolescents aged 7–17 years from the 2011 China Health and Nutrition Survey (CHNS) were used. Dietary patterns were identified using factor analysis of data from three consecutive 24-h dietary recalls. Weight and height were measured following standard methods, and BMI was calculated. Three dietary patterns were identified: modern (high intakes of milk, fast foods and eggs), traditional north (high intakes of wheat, tubers and other cereals) and traditional south (high intakes of vegetables, rice and pork). After adjusting for some confounders and total energy intake, subjects in the highest quartiles of the modern and traditional north patterns were found to have significantly greater risk of obesity (OR 3·10, 95 % CI 1·52, 6·32, and OR 2·42, 95 % CI 1·34, 4·39, respectively). In conclusion, the modern dietary pattern and the traditional north dietary pattern were associated with higher risk of obesity. Promoting healthier eating patterns could help prevent obesity in Chinese children.
To evaluate the associations between sociodemographic and psychosocial characteristics and food label (FL) use in US adults.
Data from the 1994–1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. High socio-economic status (SES) was defined as >high school education and poverty–income ratio (PIR) >350 %, low SES as <high school level or PIR <130 %. Dietary intakes were assessed using 24 h recalls.
Metropolitan statistical area-central city, -suburban, and rural areas in the USA.
US adults (n 2797; 1460 men, 1337 women) aged 20–64 years.
Approximately 80 % of Americans reported using FL, including checking the nutrition panel, list of ingredients, short phrases, serving size, or health benefits. Only 26 % used all FL information. Compared with white women of higher SES, white men, black men and women with lower SES were 77–90 % less likely to use FL. Rural residents were 40 % less likely (OR = 0·60; 95 % CI 0·42, 0·86). Participants with good nutrition knowledge, perceptions and beliefs were twice as likely to check FL for nutrient content of foods (OR = 2·28; 95 % CI 1·53–3·40). Those who were unaware of diet–disease relationships were less likely to use FL (OR = 0·53; 95 % CI 0·32–0·85). Among overweight/obese Americans (BMI ≥ 25 kg/m2), those who perceived their weight ‘about right’ were 51 % less likely to use FL than those perceiving themselves as overweight.
Men, especially black men, women of low SES, rural residents and overweight Americans with inaccurate self-perception of body weight are less likely to use FL and should be targeted for increased intervention.
To assess the predictive values of various adiposity indices for metabolic syndrome (MetS) among adults using baseline data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) cohort.
In a cross-sectional study, BMI, waist circumference (WC), body composition by dual-energy X-ray absorptiometry (DEXA) and metabolic risk factors such as TAG, HDL cholesterol, blood pressure, fasting glucose and insulin, uric acid and C-reactive protein were measured. Receiver-operating characteristic (ROC) curves and logistic regression analyses were conducted.
White and African-American US adults (n 1981), aged 30–64 years.
In predicting risk of MetS using obesity-independent National Cholesterol Education Program Adult Treatment Panel III criteria, percentage total body fat mass (TtFM) assessed using DEXA measuring overall adiposity had no added value over WC. This was true among both men (area under the ROC curve (AUC) = 0·680 v. 0·733 for TtFM and WC, respectively; P < 0·05) and women (AUC = 0·581 v. 0·686). Percentage rib fat mass (RbFM) was superior to TtFM only in women for MetS (AUC = 0·701 and 0·581 for RbFM and TtFM, respectively; P < 0·05), particularly among African-American women. Elevated percentage leg fat mass (LgFM) was protective against MetS among African-American men. Among white men, BMI was inferior to WC in predicting MetS. Optimal WC cut-off points varied across ethnic–sex groups and differed from those recommended by the National Institutes of Health/North American Association for the Study of Obesity.
The study provides evidence that WC is among the most powerful tools to predict MetS, and that optimal cut-off points for various indices including WC may differ by sex and race.
The present study aimed to scrutinize the food nutrition labelling practice in China before the Chinese Food Nutrition Labeling Regulation (CFNLR) era.
Nutrition information of pre-packaged foods collected from a supermarket between December 2007 and January 2008 was analysed and compared with findings from a survey conducted in Beijing.
Information collected from a supermarket in Shanghai.
A total of 850 pre-packaged foods.
In the Shanghai survey, the overall labelling rate was 30·9 %, similar to that found in the Beijing study (29·7 %). While only 20·5 % of the snacks in Shanghai had nutrition labelling, the percentage of food items labelled with SFA (8·6 %), trans fatty acid (4·7 %) or fibre (12·1 %) was very low. Of those food items with nutrition labels, a considerable proportion (7–15 %) did not label energy, fat, carbohydrate or protein. Food products manufactured by Taiwan and Hong Kong companies had a lower labelling rate (13·6 %) than those manufactured by domestic (31·6 %) or international manufacturers (33·8 %).
The very low food nutrition labelling rate among products sold in large chain supermarkets in major cities of China before CFNLR emphasizes the need for such critical regulations to be implemented in order to reinforce industrial compliance with accurate nutrition labelling.
Few studies have examined recent shifts in meat consumption (MC), differences among US population groups, and the influence of psychosocial–behavioural factors.
Nationally representative data collected for US adults aged ≥18 years in the 1988–1994 and 1999–2004 National Health and Nutrition Examination Survey (NHANES) and the 1994–1996 Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) were used.
We found a U-shaped trend in MC, a decrease between 1988–1994 and 1994–1996, and an increase from 1994–1996 to 1999–2004. NHANES 1988–1994 and 1999–2004 indicate that MC did not change significantly, particularly for all meat, red meat, poultry and seafood. Between 1994–1996 and 1999–2004, average MC, including red meat, poultry, seafood and other meat products, increased in men. Women’s total MC decreased, mainly due to decreased red meat and other meat products, except for increased seafood. Noticeable differences existed in the changes across population groups. Black men had the largest increase in consumption of total meat, poultry and seafood; Mexican American men had the smallest increase in poultry, seafood and other meat products. In 1999–2004, ethnic differences in MC became greater in women than among women in 1994–1996. Associations between MC and energy intake changed over time. Perceived benefit of dietary quality and food label use were associated with reduced red MC.
Noticeable differences exist in the shifts in MC across population groups and surveys. MC increased in men but decreased in women in recent years.
The validity of self-reported dietary intake is critical to the design and interpretation of diet–disease investigations. For many nutrients, there are no ideal methods to establish validity, given correlated error between reference and assessment tools, and constraints on time and resources available to perform such studies. Therefore, we quantified associations between macronutrient intakes and plasma HDL-cholesterol and TAG, relying on known associations between these factors to test the criterion validity of the FFQ used in the Multi-Ethnic Study of Atherosclerosis (MESA). Baseline dietary macronutrient intakes (derived from 120-item FFQ), and fasting plasma HDL and TAG were measured in 4510 MESA participants, aged 45–84 years. After adjusting for non-dietary factors known to affect plasma lipid concentrations, greater carbohydrate intake was associated with lower HDL and higher TAG (β per 5-unit change in percentage energy intake from carbohydrate = − 5 (se 1) mg/l (P < 0·001) for HDL and 15 (se 6) mg/l (P = 0·008) for TAG), whereas higher energy intake from fat was associated with higher HDL and lower TAG (β per 5-unit change in percentage energy from fat = 3·7 (se 2) mg/l (P = 0·01) for HDL and β = 19 (se 7) mg/l (P = 0·004) for TAG). Associations of dietary carbohydrate and fat intakes with HDL and TAG concentrations were consistent with previous studies, demonstrating criterion validity of these dietary measures in the MESA.
To test whether reduced away-from-home food expenditure (AFHFE) and better nutrition knowledge and beliefs (NKB) are associated with dietary quality among US adults.
Design and subjects
The dietary intake data (average of two 24 h recalls) used were collected from US adults (20–65 years) participating in two cross-sectional surveys, the 1994–96 Continuing Survey of Food Intake by Individuals (CSFII; n 7148) and the CSFII/Diet and Health Knowledge Survey (DHKS; n 4252).
Dietary quality was assessed using selected nutrients and food groups and the 2005 revised US Department of Agriculture Healthy Eating Index (HEI).
(i) Absolute AFHFE (weekly, per capita) and proportion of this exposure out of total food expenditure (relative expenditure); (ii) NKB score using a composite of an eleven-item scale elicited among the CSFII/DHKS subgroup.
Statistical analyses performed
We used t tests, χ2 tests, Wilcoxon rank-sum tests and multivariate linear regression models adjusting standard errors for sample design complexity. We utilized a change-in-estimate approach to assess mediation. For effect modification, we tested the significance of interaction terms (NKB × AFHFE).
Absolute AFHFE was positively associated with grams of fat (β = 0·14 (se 0·06)) and saturated fat (β = 0·02 (se 0·01)) and negatively associated with fibre (β = −0·02 (se 0·01)) and HEI (β = −0·08 (se 0·01)). Relative AFHFE mediated NKB effects on intakes such as fat, saturated fat, cholesterol, Na, and fruits and vegetables (change in estimate >10 %). Among subjects with a poor NKB score, higher AFHFE resulted in lower diet quality, particularly Na and cholesterol intakes.
Higher AFHFE was associated with a lower dietary quality and interacted antagonistically with NKB in some instances, while mediating the relationship between NKB and dietary quality in others.
To assess overweight and related risk factors among urban low socio-economic status (SES) African-American adolescents in an attempt to study the underlying causes of ethnicity and gender disparities in overweight.
Cross-sectional data collected on anthropometric measures, diet, physical activity and family characteristics from 498 students in grades 5–7 in four Chicago public schools were analysed to study the risk factors for overweight using stepwise regression analysis.
Only 37.2% of the students lived with two parents. Nearly 90% had a television (TV) in their bedroom, and had cable TV and a video game system at home. Overall. 21.8% (17.7% boys versus 25.1% girls) were overweight (body mass index (BMI) ≥ 95th percentile); and 39.8% had a BMI ≥ 85th percentile. Compared with national recommendations, they had inadequate physical activity and less than desirable eating patterns. Only 66.1% reported having at least 20 min vigorous exercise or 30 min of light exercise in ≥ 5 days over the past 7 days; 62.1% spent >3 h days− 1 watching TV/playing video games/computer, while 33.1% spent ≥ 5 h days− 1. Their vegetable and fruit consumption was low, and they consumed too many fried foods and soft drinks: 55.1% consumed fried food twice or more daily and 19.5% four times or more daily; 70.3% consumed soft drinks twice or more daily and 22.0% four times or more daily on average. Gender, physical activity and pocket money were significant predictors of overweight (P < 0.05).
Several factors in the students' behaviours, school and family environments may increase overweight risk among this population. There is a great need for health promotion programmes with a focus on healthy weight and lifestyle, and targeting urban low-SES minority communities.
To study the dynamics of childhood overweight and the influence of dietary intake on tracking of overweight.
Design and setting:
A follow-up study conducted in China.
Ninety-five overweight children, 6–13 years old, identified from 1455 children at baseline, were followed over a 2-year period.
Data on anthropometry and 3-day dietary intake were collected at baseline and during follow-up. Overweight was defined using the International Obesity Task Force reference of body mass index (BMI)-for-age. Differences between groups were tested using analysis of variance and Cochran-Mantel-Haenszel tests.
Of the 95 overweight children, 36.8% remained overweight 2 years later (‘tracking group’). Urban boys were the three times more likely than rural boys to remain overweight (63.2% vs. 21.9%). At baseline, the tracking group had higher BMI, body weight and fat intake (% of energy), and lower carbohydrate intake (% of energy), than the non-tracking group (who shifted from overweight to not overweight); they were more likely to have a high-fat or high-meat diet, but less likely to have a diet high in carbohydrate or vegetables and fruit. During the follow-up, the tracking group increased fat intake and reduced carbohydrate intake while the non-tracking group did not; and they also grew slower in height but faster in weight. Tracking of overweight seemed to be related to tracking of high-meat (relative risk (RR) 2.4, 95% confidence interval (CI) 1.0–5.6, P < 0.05) and high-fat (RR 1.5, 95% CI 0.9–2.5, P < 0.1) diets.
Considerable changes in children's overweight status during childhood and adolescence were observed in China, a transitional society. Dietary patterns, particularly dietary composition, seemed to influence the tracking patterns of overweight.
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