Xiaoyue Xu

Dietary pattern is associated with obesity in older people in China: data from China Health and Nutrition Survey (CHNS)

Background: No studies have been conducted to explore the associations between dietary patterns and obesity among older Chinese people, by considering gender and urbanization level differences. Methods: We analyzed data from the 2009 China Health and Nutrition Survey (2745 individuals, aged ≥ 60 years). Dietary data were obtained using 24 h-recall over three consecutive days. Height, Body Weight, and Waist Circumference were measured. Exploratory factor analysis was used to identify dietary patterns. Multinomial and Poisson regression models were used to examine the association between dietary patterns and Body Mass Index (BMI) status/central obesity. Results: The prevalence of general and central obesity was 9.5% and 53.4%. Traditional dietary pattern (high intake of rice, pork and vegetables) was inversely associated with general/central obesity; modern dietary pattern (high intake of fruit, fast food, and processed meat) was positively associated with general/central obesity. The highest quartile of traditional dietary pattern had a lower risk of general/central obesity compared with the lowest quartile, while an inverse picture was found for the modern dietary pattern. These associations were consistent by gender and urbanization levels. Conclusions: Dietary patterns are associated with general/central obesity in older Chinese. This study reinforces the importance of a healthy diet in promoting healthy ageing in China.

Evaluation of older Chinese people's macronutrient intake status: results from the China Health and Nutrition Survey

Little is known about the macronutrient intake status of older Chinese people. The present study evaluated the macronutrient intake status of older Chinese people (aged ≥ 60 years), investigated whether they had intake levels that met the Dietary Reference Intakes (DRI), and explored the associations between macronutrient intakes and age groups, sex, education levels, work status, BMI groups, urbanicity levels and four socio-economic regions of China (Northeast, East Coast, Central and Western). Dietary intake data of 2746 older Chinese with complete dietary intake data in the Longitudinal China Health and Nutrition Survey (2009 wave) carried out across four diverse regions were analysed. Dietary intake data were obtained by interviews using 24 h recalls over three consecutive days. The MUFA:SFA ratios were calculated based on the Chinese Food Composition Table. Less than one-third of the older Chinese people included in the present study had intake levels meeting the adequate intake for carbohydrate-energy and fat-energy; less than one-fifth had intake levels meeting the recommended nutrient intake for protein-energy; and more than half of the older people had fat-energy intakes higher than the DRI. There were strong associations between the proportions of energy from the three macronutrients and education levels, urbanicity levels and the four socio-economic regions of China, with older people living in the East Coast region having different patterns of macronutrient-energy intakes when compared with those living in the other three regions. Macronutrient intakes across different urbanicity levels in the four regions revealed considerable geographical variations in dietary patterns, which will affect the risk factors for non-communicable diseases. Clinical interventions and public health policies should recognise these regional differences in dietary patterns.

Assessing Dietary Quality of Older Chinese People Using the Chinese Diet Balance Index (DBI)

Background/Objectives Few studies have applied the Chinese Diet Balance Index (DBI) in evaluating dietary quality for Chinese people. The present cross-sectional study assessed dietary quality based on DBI for older people, and the associated factors, in four socioeconomically distinct regions in China. Methods The China Health and Nutrition Survey (CHNS) involves 2745 older Chinese people, aged 60 or over, from four regions (Northeast, East Coast, Central and West) in 2009. Dietary data were obtained by interviews using 24 hour-recall over three consecutive days. Four indicators: Total Score (TS), Lower Bound Score (LBS), Higher Bound Score (HBS) and Diet Quality Distance (DQD) from DBI were calculated for assessing dietary quality in different aspects. Results 68.9% of older people had different levels of excessive cereals intake. More than 50% of older people had moderate or severe surplus of oil (64.9%) and salt (58.6%). Intake of vegetables and fruit, milk and soybeans, water, and dietary variety were insufficient, especially for milk and soybeans. 80.8% of people had moderate or severe unbalanced diet consumption. The largest differences of DQD scores have been found for people with different education levels and urbanicity levels. People with higher education levels have lower DQD scores (p<0.001), and people living in medium and low urbanicity areas had 2.8 and 8.9 higher DQD scores than their high urbanicity counterparts (p<0.001). Also, significant differences of DQD scores have been found according to gender, marital status, work status and regions (p<0.001). Conclusion DBI can reveal problems of dietary quality for older Chinese people. Rectifying unbalanced diet intake may lead to prevention of non-communicable diseases (NCDs). Dieticians and health care professionals need to increase dissemination and uptake of nutrition education, with interventions targeted at regions of lower socioeconomic status.

Do older Chinese people’s diets meet the Chinese Food Pagoda guidelines? Results from the China Health and Nutrition Survey 2009

OBJECTIVE To evaluate dietary intake based on the Chinese Food Pagoda (CFP) and to determine what factors may be associated with adherence to CFP guidelines for older Chinese. DESIGN This cross-sectional population-based study used 24 h recall over three consecutive days to assess dietary intake and adherence to CFP among older Chinese participating in the China Health and Nutrition Survey 2009. SETTING Nine provinces across four diverse regions (Northeast, East Coast, Central and West). SUBJECTS A total of 2745 older Chinese, aged 60-69 years (n 1563) and ≥70 years (n 1182), with dietary data. RESULTS None of the participants reached all ten food group recommendations. More than half of the participants exceeded the recommended amount for grains (63%), oil (62·8%) and salt (55·7%). Ten per cent of the participants consumed dairy, while merely 0·5% met the recommended amount. Average Chinese Food Pagoda Score (CFPS) was 3·3 in men and 3·5 in women, far below the maximum possible score of 10. Women had 0·26 higher CFPS than men (P<0·001; 95% CI 0·16, 0·36). People living in medium and high urbanicity areas had significantly higher scores than those living in low urbanicity areas (P<0·001). Also, there were significant differences in CFPS according to gender, BMI, work status, education level and region. CONCLUSIONS Few older Chinese are meeting the intake of the various food groups based on the recommendations in the CFP guidelines, thus increasing the risk of malnutrition and non-communicable diseases. Action is needed to increase dissemination and uptake of nutrition education, with interventions targeted at socio-economic regions. Moreover, specific dietary guidelines for older Chinese people should be developed.

Evaluation of successful aging among older people in China: Results from China health and retirement longitudinal study.

China faces a “time‐bomb” of the aging population. Successful aging has long been a goal in the field of gerontology. The present study aimed to evaluate successful aging among Chinese older adults.

Association between nighttime sleep and successful aging among older Chinese people

OBJECTIVE This study aims to assess the association between sleep and successful aging among Chinese ≥60 years of age. METHODS Data were collected from the baseline survey of the China Health and Retirement Longitudinal Study. Two self-reported questions about sleep quality and duration were examined. Successful aging was defined following Rowe and Kahns multidimensional model. To assess the adjusted association between sleep and successful aging, multivariable logistic regression was applied. RESULTS The average number of self-reported hours of sleep was 6.2 ± 2.0 among older Chinese people. Successful aging was related to sleep duration, with the proportion of those adults considered to be aging successfully falling into the following sleep duration categories (<6 h - 7.8%; 6 h - 16.3%; 7 h - 19.1%; 8 h - 14.7%; and ≥9 h - 12.8%). The plots between sleep duration and successful aging were an inverse U-shape. Participants who slept less than 6 h per day had lower odds ratios of successful aging [odds ratio (OR) = 0.52, 95% confidence interval (CI) 0.40-0.67] relative to those who slept for 7 h per day. Compared with those who reported poor sleep less than once a week, older people who reported poor sleep five to seven days a week showed a lower ratio of successful aging (OR = 0.29, 95% CI 0.21-0.39). CONCLUSION Older age, shorter or longer sleep, and poor sleep were related to lower odds of, rates of successful aging. Most older Chinese adults experience insufficient sleep and poor sleep quality, which could be an important influential factor in successful aging.

Differences in depression between unknown diabetes and known diabetes: results from China health and retirement longitudinal study

BACKGROUND Both diabetes and depression have become serious public health problems and are major contributors to the global burden of disease. People with diabetes have been shown to have higher risk of depression. The purpose of this study was to observe the differences in depression between older Chinese adults with known or unknown diabetes. METHODS Data came from the national baseline survey of China Health and Retirement Longitudinal Study (CHARLS). The Center for Epidemiologic Studies Depression Scale was used to assess depression. Participants with a history of diabetes diagnosis were considered to have known diabetes, and those with newly-diagnosed diabetes were considered to have unknown diabetes. Multiple logistic regression analysis was applied to estimate odds ratio (OR) for depression in predictor variables. RESULTS Overall, 39.1% of the 2,399 participants with diabetes suffered from depression. The prevalence of depression was significantly higher (p < 0.001) in people with known diabetes (43.5%) than those with unknown diabetes (35.1%). The biggest differences between the two groups were found in the middle aged, in women, in the less educated and in married people. In known diabetes, people treated with traditional Chinese medicine (TCM) coupled with oral western medicine (WM) and/or insulin had two-fold odds of depression compared to those without treatment. CONCLUSION The knowledge of having diabetes, treatments and suffering from other chronic diseases were associated with the higher prevalence of depression in people with known diabetes compared to those with unknown diabetes. Prevention of depression in diabetics should receive more attention in the middle aged, women and the less education.

Differences in food and nutrient intakes between Australian- and Asian-born women living in Australia: Results from the Australian Longitudinal Study on Women's Health: Nutrition differences between Australian- and Asian-born women

AIM To determine differences in food and nutrient intakes between Australian- and Asian-born women living in Australia. METHODS Data were obtained from the Australian Longitudinal Study on Womens Health, including 6461 women born in Australia or Asia who completed food frequency questionnaires in 2001 and 2013. Diet was assessed using the Dietary Questionnaire for Epidemiological Studies version 2. Longitudinal generalised estimating-equation modelling was performed to determine the effect of country of birth and survey year on fruit and vegetable intake. RESULTS Asian-born women ate more cereals, soybeans and fish but less vegetables, legumes, dairy, meat and meat products than Australian-born women both in 2001 and in 2013. Asian-born women ate less cereals, rice and noodles, meat and its products (P < 0.05) in 2013 than in 2001. The earlier people came to Australia, the less their rice and noodle intake per day. However, the reverse was demonstrated regarding vegetable intake. Asian-born women had a lower daily intake of fat, calcium, zinc, thiamin, riboflavin, folate and retinol compared with those born in Australia. CONCLUSIONS Asian-born women living in Australia show different food and nutrient intakes from Australian-born women, although their diets tend to deviate from typical Asian characteristics and approach a Western diet.

Factors influencing choice of skilled birth attendance at ANC: evidence from the Kenya demographic health survey

BackgroundIn Kenya, skilled attendance at delivery is well below the international target of 90% and the maternal mortality ratio is high at 362 (CI 254–471) per 100,000 live births despite various interventions. The preventative role of skilled attendance at delivery makes it a benchmark indicator for safe motherhood.MethodsMaternal health data from the Service Provision Assessment Survey, a subset of the 2010 Kenya Demographic Health Survey was analyzed. Logistic regression models were employed using likelihood ratio test to explore association between choice of skilled attendance and predictor variables.ResultsOverall, 94.8% of women are likely to seek skilled attendance at delivery. Cost, education level, number of antenatal visits and sex of provider were strongly associated with client’s intention to deliver with a skilled birth attendant at delivery. Women who reported having enough money set aside for delivery were 4.34 (p < 0.002, 95% CI: 1.73; 10.87) times more likely to seek skilled attendance. Those with primary education and above were 6.6 times more likely to seek skilled attendance than those with no formal education (p < 0.001, 95% CI: 3.66; 11.95). Women with four or more antenatal visits were 5.95 (p < 0.018, 95% CI: 1.35; 26.18) times more likely to seek skilled attendance. Compared to men, female providers impacted more on the client’s plan (OR = 2.02 (p < 0.014, 95% CI: 1.35; 3.53).ConclusionInterventions aimed at improving skilled attendance at delivery should include promotion of formal education of women and financial preparation for delivery. Whenever circumstances permit, women should be allowed to choose gender of preferred professional attendant at delivery.

Where is the nurse in nutritional care

Nurses have the expertise and responsibility to ensure that patients and clients’ nutritional needs are met. Providing nutrition screening and appropriate nutrition advice is essential to improve h...