Yi Zhai

Economic burden of obesity-related chronic diseases in Mainland China.

The objectives of the present study are: (i) to estimate annual direct medical costs of chronic diseases attributable to overweight and obesity among adults in China and (ii) to predict the medical costs if the epidemic continues developing. Using 2002 National Nutrition and Health Survey (n = 39 834), the prevalence of overweight [24 ≥ body mass index (BMI) < 28] and obesity (BMI ≥ 28), and population attributable risks (PARs) for hypertension, type 2 diabetes, coronary heart disease and stroke were calculated. The 2003 third National Health Services Survey (n = 143 521) was used to derive direct medical costs including costs for outpatient visits, physician services, inpatient stays, rehabilitation services, nursing fees and medications. The medical costs attributable to overweight and obesity were estimated by multiplying the disease costs by PAR for each disease. The total medical cost attributable to overweight and obesity was estimated at 21.11 billion Yuan (RMB) (∼

The role of dietary factors in chronic disease control in China.

2.74 billion) accounting for 25.5% of the total medical costs for the four chronic diseases, or 3.7% of national total medical costs in 2003. The medical cost associated with overweight and obesity could increase to 37 billion Yuan (RMB) (∼

High normal plasma triglycerides are associated with preserved cognitive function in Chinese oldest-old

4.8 billion), a 75% increase, if the epidemic developed speedily and the ratio of overweight to obesity approached 1.1:1. The high economic burden of overweight and obesity suggests an urgent need to develop effective interventions for controlling the obesity epidemic and consequently the prevention of chronic diseases.

Association of children’s eating behaviors with parental education, and teachers’ health awareness, attitudes and behaviors: a national school-based survey in China

Using the dietary intake and chronic disease condition data of 39 843 adults aged over 18 years old from the 2002 National Nutrition and Health Survey in China (2002 CNHS) logistic regression analysis was applied to calculate the odd ratios (ORs) of hypertension, diabetes and dyslipidaemia for the various dietary patterns of the subjects. The higher percentage of energy intake from cereals was significantly associated with lower body mass index (BMI), lower total serum cholesterol (TC) and lower low density lipoprotein cholesterol (LDL‐C), while it was significantly associated with lower risk of overweight/obesity, hypertension, high TC, high serum triglycerides (TG) and high LDL‐C, but the prevalence of underweight was significantly higher in the cluster of subjects with cereal energy share more than 75%. The higher percentage of energy intake of fat was related to higher BMI, higher TC and higher LDL‐C which were associated with a high risk of overweight/obesity, hypertension, TC and TG. The study confirmed the important role of dietary pattern in chronic disease control. In particular, an optimum energy contributed from cereals ranged from 55% to 65% of total dietary energy intake and dietary fat energy share no more than 30% which should be the focus of preventive measures.

Changes in Waist Circumference and Abdominal Obesity among Chinese Adults over a Ten-year Period

OBJECTIVE to explore the relationship between blood lipids/lipoproteins and cognitive function in the Chinese oldest-old. DESIGN multivariate statistical analysis using cross-sectional data. SETTING community-based setting in longevity areas in China. SUBJECTS eight hundred and thirty-six subjects aged 80 and older were included in the sample. METHODS plasma total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, blood pressure and fasting plasma glucose were measured and information about demographics and lifestyle was collected. Cognitive status was assessed using the Mini-Mental State Examination (MMSE). RESULTS cumulative logit model analysis showed that triglyceride was significantly negatively associated with cognitive impairment. By general linear modelling, there was a significant linear trend of MMSE scores with the level of triglyceride, but not with levels of cholesterol after adjustment. The odds ratio (OR) of cognitive impairment (MMSE score < 18) was significantly reduced for the highest quartile of plasma triglyceride concentration (OR: 0.52, 95% CI: 0.33-0.84), but not for the second or third quartile, compared with the lowest quartile (adjusted models). There were no significant associations between cognitive impairment and cholesterol. CONCLUSION we concluded that high normal plasma triglyceride was associated with preservation of cognitive function while lower concentrations were not in the Chinese oldest-old.

Results of the parent-rated Strengths and Difficulties Questionnaire in 22,108 primary school students from 8 provinces of China

BACKGROUND In China, childhood obesity is a growing health issue. Eating behaviors among children can be influenced by both the family and school environment. We examine the association between these environments and eating habits among children. METHODS A total of 11 270 fourth to sixth grade school children, 11 270 of their fathers or mothers, and 1348 teachers from 48 schools were sampled using a multistage cluster random sampling method. Questionnaires collected information on eating behaviors among children, non-communicable chronic disease (NCD)-related health knowledge and behaviors among teachers, and education levels among parents. Mixed effect logistic regression models were used to describe the key associations between eating behaviors among children and teacher and parental characteristics. RESULTS Health awareness, positive health attitudes, never-smoking and regular-exercise among teachers was positively associated with healthy eating behaviors among their students (having breakfast, vegetables and dairy products every day; P < 0.05), and negatively associated with the unhealthy behaviors (daily intake of fried foods and desserts and sugary beverages; P < 0.05). More than one parent having a high school level or above was positively related to healthy eating behaviors among their children (P < 0.05), but its associations with high-calorie eating habits were negative in urban and positive in rural areas (P < 0.05). CONCLUSIONS School-based interventions which target health-related awareness, attitude and behaviors among school teachers may help improve school-aged childrens eating behaviors. Parental education levels may help guide efforts to target children at higher risk of unhealthy eating habits.

High Sensitivity C-Reactive Protein Associated with Different Health Predictors in Middle-Aged and oldest old Chinese

OBJECTIVE The aim of this study was to describe changes in waist circumference (WC) and prevalence of abdominal obesity over a period of 10 years among Chinese adults in different socio-economic status (SES). METHODS Data derived from the China Nutrition and Health Surveillance during 2002 and 2010-2012. We calculated the mean WC and the prevalence of abdominal obesity by gender, place of residence, SES indicators (education, income, and marital status), and body mass index (BMI) categoriesand used pooled t-tests to assess the differences between the two time periods. RESULTS 26.0% of men and 25.3% of women had abdominal obesity in 2010-2012. The age-adjusted mean WC increased by 2.7 cm among men and 2.1 cm among women; the age-adjusted prevalence of abdominal obesity increased by 7.7% among men and 5.3% among women. The rising trends were observed in all subgroups except for a negative growth in high-income women. People living in rural areas with low education and income and with a BMI of 18.5 to 23.9 kg/m2 had a greater absolute and relative increase in WC. People living in rural areas with low income had a greater relative increase in abdominal obesity. CONCLUSION The mean WC and prevalence of abdominal obesity among Chinese adults have increased during the past 10 years. Gender differences were noted using various SES indicators.

Gender Differences in the Prevalence of Overweight and Obesity, Associated Behaviors, and Weight-related Perceptions in a National Survey of Primary School Children in China

Background A valid screening tool for behavioral and emotional problems in children and adolescents is needed to promote psychological wellbeing and to prevent mental disorders in Chinas children. Aim Assess the use of the Chinese version of the internationally recognized Strengths and Difficulties Questionnaire (SDQ) – which assesses emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviors – in a large sample of urban and rural children from different parts of China. Methods The Chinese version of the parent-reported SDQ was administered to legal guardians (primarily parents) of a stratified random sample of 22,108 primary school children 5 to 13 years of age from eight provinces in China. The association between SDQ scores and socio-demographic characteristics was assessed and the percentile cutoff scores for ‘abnormal’, ‘borderline’ and ‘normal’ results in China were compared with those for Japan and the United Kingdom. Results The internal consistency of the 4 of the 5 SDQ subscales were satisfactory but that for the ‘peer relationships problems’ subscale was quite poor (alpha=0.22). Guardians reported that boys were more likely than girls to have hyperactivity/inattention problems and that girls were more likely than boys to have problems with emotional symptoms. For both boys and girls hyperactivity/inattention problems decreased with age while peer relationship problems increased with age. Emotional symptoms, conduct problems and peer relationship problems were more common in children from rural areas and in children whose identified guardian was not a parent (i.e., a grandparent or other relative). The 90th percentile cutoff score for abnormal results was higher in Chinese children than the cutoff scores reported for children in Japan and the United Kingdom. Conclusions This study suggests that prevention programs for hyperactivity/inattention problems in boys need to start before the age of 10 and that training in methods of reducing the stress associated with peer relationships should start in early adolescence. Further work is needed to improve the cultural validity of the SDQ in China and to determine its sensitivity and specificity for identifying children who are in need of mental health services.

Effectiveness Analysis on the Physical Activity and the Health Benefit of a Community Population Based Program

OBJECTIVE To describe the distribution of plasma high sensitivity C-reactive protein (hsCRP) and explore the relationship between hsCRP and metabolic risk factors among residents living in longevity areas of China. METHODS 268 individuals aged between 40 and 59 years and 506 individuals aged over 90 years were selected from 5 longevity areas of China to participate in a cross section longitudinal cohort study. The participants were interviewed with general health related questionnaire to collect their demographic, behavioral and lifestyle data, as well as their chronic conditions, and meanwhile their physical and biomedical parameters including waist circumference (WC), blood pressure (BP), hsCRP, plasma lipids, and fasting blood glucose (FBG) were measured. RESULTS The median of hsCRP was 0.99 mg/L in the middle-aged group and 1.76 mg/L in the oldest old group. No significant gender difference was observed between the above two groups. Among the oldest old individuals, 36.56% had an hsCRP level >3.0 mg/L. The prevalence of high hsCRP was 16.79% in the middle-aged group. The results of stepwise multiple linear regression analyses showed that HDL-C was independently associated with ln (hsCRP) concentration in the middle-aged group, whereas ln (TG), HDL-C and FBG were correlated after adjustment for gender, study site, smoking, drinking, education and BMI in the oldest old group. CONCLUSION HDL-C is a stronger predictor of elevated hsCRP than other metabolic factors in the middle-aged population. For the oldest old persons, high TG, low HDL-C, and FBG predict elevated plasma hsCRP.

Dietary Patterns Associated with Cognitive Function among the Older People in Underdeveloped Regions: Finding from the NCDFaC Study

OBJECTIVE To in vestigate potential gender differences in the odds of overweight/obese, weight-related perceptions, and behaviors among Chinese school children. METHODS Height, weight, and a survey of weight-related perceptions and behaviors were measured in a nationally representative survey of 12,811 children in primary schools in China. Logistic regression analyses were used to assess gender differences, adjusting for confounders. RESULTS Boys had higher odds of being overweight/obese compared to girls within both urban [adjusted odds ratio (OR) 2.30, 95% CI 2.00 to 2.65] and rural areas (OR = 1.85, 95% CI 1.55 to 2.20). Girls reported healthier diets (e.g., daily vegetables OR = 0.79, 95% CI 0.73 to 0.85) whereas boys consumed fried food (OR = 1.21, 95% CI 1.06 to 1.38) and sugar-sweetened drinks more often (OR = 1.49, 95% CI 1.34 to 1.65). Gender differences included higher odds of boys perceiving themselves as overweight if they had more highly educated mothers (OR = 1.35, 95% CI 1.09 to 1.68), less educated fathers (OR = 0.79, 95% CI 0.63 to 0.99), and if they frequently consumed carbonated drinks (OR = 1.48, 95% CI 1.07 to 2.05). CONCLUSION Childhood obesity prevention in China should be gender-focused, particularly for boys who reported an unhealthier diet but were less likely to see they were fat, even though more boys were overweight or obese than girls.