Yide Yang

A school-based education programme to reduce salt intake in children and their families (School-EduSalt): protocol of a cluster randomised controlled trial

Introduction The current salt intake is very high for children as well as adults in China. A reduction in salt intake is one of the most cost-effective measures to curb the rapidly growing disease burden attributed to blood pressure and cardiovascular disease in the Chinese population. A lower salt diet starting from childhood has the potential to prevent the development of such conditions. The School-EduSalt (School-based Education Programme to Reduce Salt) study aims to determine whether an education programme targeted at school children can lower salt intake in children and their families. Methods and analysis The study is designed as a cluster randomised controlled trial. The location is Changzhi, Shanxi province in northern China. The study population will consist of 28 primary schools with 280 children aged ≈11 years and 560 adult family members. Children in the intervention group will be educated on how to reduce salt intake. They will then be empowered to deliver the salt reduction message home to their families. In particular, children need to persuade the person who does the cooking to reduce the amount of salt used during food preparations. The duration of the intervention is one school term (≈4.5 months). The primary outcome is the difference between the intervention and the control group in the change in 24 h urinary sodium and the secondary outcome is the difference between the intervention and control group in the change of blood pressure. An economic evaluation will be undertaken to assess cost-effectiveness. Ethics and dissemination The study has been approved by The Queen Mary Research Ethics Committee (QMREC2012/81) and Peking University Health Science Centre IRB (IRB00001052-12072). Study findings will be disseminated widely through conference presentations and peer-reviewed publications. Protocol Registration Protocol Registered on ClinicalTrials.gov NCT01821144.

HIF3A DNA Methylation Is Associated with Childhood Obesity and ALT.

Gene polymorphisms associated so far with body mass index (BMI) can explain only 1.18–1.45% of observed variation in BMI. Recent studies suggest that epigenetic modifications, especially DNA methylation, could contribute to explain part of the missing heritability, and two epigenetic genome-wide analysis studies (EWAS) have reported that Hypoxia Inducible Factor 3 Alpha Subunit (HIF3A) methylation was associated with BMI or BMI change. We therefore assessed whether the HIF3A methylation is associated with obesity and other obesity-related phenotypes in Chinese children. The subjects included 110 severe obese cases aged 7–17y and 110 normal-weight controls matched by age and gender for measurement of blood DNA methylation levels at the HIF3A gene locus using the Sequenom’s MassARRAY system. We observed significantly higher methylation levels in obese children than in controls at positions 46801642 and 46801699 in HIF3A gene (P<0.05), and found positive associations between methylation and alanine aminotransferase (ALT) levels adjusted by gender, age and BMI at the position 46801699 (r = 0.226, P = 0.007). These results suggest that HIF3A DNA methylation is associated with childhood obesity, and has a BMI-independent association with ALT. The results provide evidence for identifying epigenetic factors of elivated ALT and may be useful for risk assessment and personalized medicine of liver diseases such as non-alcoholic fatty liver disease (NAFLD).

Intensified association between waist circumference and hypertension in abdominally overweight children

BACKGROUND Abdominal adiposity is an important risk factor for childhood hypertension. The present study aimed to compare the strength of the association between waist circumference (WC) and hypertension in children with different WC levels. METHODS A total of 82,413 Chinese children aged 9-17 years were selected. An abdominally overweight child was defined as a child with WC ≥75th sex- and age-specific percentile. Hypertension was categorised as ≥95th sex-, age- and height-specific percentile. Logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of WC for hypertension after WC was transformed into sex- and age-specific z-score. RESULTS Abdominally overweight children presented a higher risk of hypertension (OR: 2.39; 95% CI: 2.26, 2.54) than children with normal WC. In children with normal WC, one sex- and age-specific standard deviation increase in WC was associated with a 42% increase in odds of hypertension (OR: 1.42; 95% CI: 1.30, 1.55). That increase was elevated to 74% in abdominally overweight children (OR: 1.74; 95% CI: 1.66, 1.82). A similar pattern was also observed in different sex and area groups, and in children 9-14 years old. CONCLUSIONS An intensified association between WC and hypertension was observed in abdominally overweight Chinese children. The gain in WC was associated with greater increase in hypertensive risk in abdominally overweight children than that of children with normal WC. These findings could improve intervention strategies for hypertension risk reduction in children.

Effects of Integrated Health Management Intervention on Overweight and Obesity

Overweight or obese adults aged 20~55 years and living in Beijing more than one year were randomly divided into different management groups. A one-year integrated health management intervention was applied in the health management groups. The physical indicators and metabolic indicators changed after one-year intervention on the overweight and obese adults. The annual reduction of the physical indicators was significant in all groups (p < 0.05) except the weight loss in the placebo + general management group. The health management and the dietary supplement have statistically significant (p < 0.001, p < 0.001) effects on the annual reduction of these indicators and interactive effect between them was found on some of these indicators such as bodyweight, body mass index (BMI), body fat ratio (BFR), and hipline (p < 0.05). The dietary supplement + health management group had the best annual reduction effects for the indicators among the groups. Integrated health management interventions including both dietary supplements intervention and health management could improve metabolic indicators in overweight and obese adults together with the physical indicators, suggesting the intermediated role of metabolic indictors in controlling obesity.

Associations among cardiorespiratory endurance, body mass index and blood pressure in Han Chinese children: results from the 2010 Chinese National Survey On Students’ Constitution and Health

The associations among cardiorespiratory endurance (CRE), body mass index (BMI) and blood pressure (BP) in children are still unclear. This study aimed to examine the relationships among CRE, BMI and BP in Chinese children. Data were derived from the 2010 Chinese National Survey on Students’ Constitution and Health. An endurance run test was used to determine CRE and children were stratified into low and high/moderate CRE groups. BMI was dichotomized into non-overweight and overweight. Among overweight children aged 7–12 years, the risk of high BP (HBP) was significantly higher in the low CRE group than in the high/moderate CRE group (in boys, odds ratio=1.13, 95% confidence interval: 1.03–1.24, P=0.010; in girls, odds ratio=1.18, 95% confidence interval: 1.04–1.33, P=0.010) after adjusting for age, BMI, socioeconomic status and area of residence. However, among all children aged 13–18 years and non-overweight children aged 7–12 years, we did not observe similar results. Higher CRE is associated with lower BP. Overweight children have a significantly higher risk of HBP and low CRE may increase the risk of HBP, independently of BMI, among 7- to 12-year-old overweight children.

Role of waist measures in addition to body mass index to assess the hypertension risk in children

Abstract Aim: This study aimed to evaluate whether waist measures, including waist circumference (WC) and waist-to-height ratio (WHtR), can improve the ability of body mass index (BMI) to assess the hypertension risk when used as continuous variables. Methods: In this cross-sectional study, 82 432 Chinese children aged 9–17 years were included. Elevated BP was defined using age-sex-and-height-specific references. Logistic regression model and area under the receiver operating characteristic curve (AUC) were performed after BMI and waist measures were converted into age-and-sex-based z-scores. Results: WHtR, but not WC, was associated with elevated BP after adjusting for BMI, with the odds ratios ranging between 1.14 (95% confidence interval: 1.04, 1.25) and 1.30 (1.21, 1.39) for one unit increase in WHtR z-score. Combined use of BMI and WHtR z-scores showed a significantly larger AUC than BMI alone (p < 0.05), while joint use of BMI and WC was not better than BMI alone. Conclusion: WHtR, rather than WC, provided further information on hypertension risk beyond that provided by BMI alone when used as a continuous variable. This study suggests WHtR, in addition to BMI, should be included for the assessment of childhood adiposity in routine paediatric practice.

Association between Vegetable Consumption and Blood Pressure, Stratified by BMI, among Chinese Adolescents Aged 13–17 Years: A National Cross-Sectional Study

The association between vegetable intake and blood pressure (BP) in adolescents is still inconsistent, and the description of the recommended daily vegetable consumption is abstract and nonfigurative. Here we aimed to investigate the association between vegetable consumption and BP and further look for a simple way to describe a satisfactory level of daily vegetable consumption for adolescents. We recruited 18,757 adolescents, aged 13–17 years, from seven provinces in China in 2013. A standard physical examination, including height, weight and BP was conducted. Information regarding vegetable intake was collected by questionnaire, and one serving of vegetables was defined as the size of an adult’s fist. Multivariable linear and logistic regression models were used for analysis after adjusting for covariates. Approximately 12.2%, 38.0%, 28.7%, and 21.1% of the adolescents reported daily vegetable consumption of <1, 1~2, 2~3, and ≥3 servings, respectively. Adolescents whose daily vegetable consumption was ≥3 servings showed a lower risk of high blood pressure (HBP) (OR = 0.74, 95%CI: 0.58~0.94, p = 0.013) compared to those with daily vegetable consumptions of < 1 serving. When stratified by body mass index (BMI), in overweight adolescents, participants with 2~3 or ≥3 servings/day had an OR of 0.66 (95%CI: 0.45~0.97) or 0.63 (95%CI: 0.42~0.95) compared with the reference group. Daily vegetable intake of at least three servings (three adult’s fists) is associated with a lower HBP risk in adolescents, which leads to a simple message: “consuming at least three fists of vegetables every day will improve your blood pressure profile”.

Genetic variations in sterol regulatory element binding protein cleavage-activating protein ( SCAP ) are associated with blood pressure in overweight/obese Chinese children

Objective Previous studies demonstrated a role of variations in sterol regulatory element binding protein (SREBP) cleavage-activating protein (SCAP) in obesity and blood lipids. But the associations between SCAP polymorphisms and blood pressure (BP) are not clear. This study aimed to investigate the relationship between genetic variations in SCAP and BP phenotypes in a Chinese pediatric population. Methods A case-control study on 702 high blood pressure (HBP) children and 1319 controls was conducted to explore the correlation between single nucleotide polymorphism markers (rs12487736 and rs12490383) of SCAP and BP phenotypes. The associations with continuous and categorical variables were examined by linear regression and logistic regression models under a dominant genetic model for the minor rs12487736 A allele and rs12490383 T allele. Results The rs12487736 polymorphism was significantly associated with systolic BP (SBP) (β = 1.66, P = 0.003) and diastolic BP (DBP) (β = 1.35, P = 0.024) with age, age-squared, sex, study population and body mass index (BMI) adjusted under the dominant genetic model. The rs12490383 polymorphism was significantly associated with SBP (β = 1.71, P = 0.004) and SHBP (OR = 1.39, 95%CI: 1.04–1.86, P = 0.027). When analyzed by BMI categories, in the normal-weight children, no significant association between the SCAP polymorphisms and BP phenotypes was observed (all P > 0.05). However, in the overweight/obese children, rs12487736 was significantly associated with SBP (β = 1.6, P = 0.019) and SHBP (OR = 1.36, 95%CI: 1.02–1.82; P = 0.037), rs12490383 was associated with SBP (β = 2.04, P = 0.004) and SHBP (OR = 1.50, 95%CI: 1.10–2.05; P = 0.01). Conclusions This study demonstrated that SCAP rs12487736 and rs12490383 were significantly associated with SBP and SHBP in overweight/obese Chinese children. It provided the evidence for association of SCAP with SBP.

Association Study of Three Gene Polymorphisms Recently Identified by a Genome-Wide Association Study with Obesity-Related Phenotypes in Chinese Children

Objective: This study aimed to examine associations of three single-nucleotide polymorphisms (SNPs) with obesity-related phenotypes in Chinese children. These SNPs were identified by a recent genome-wide association (GWA) study among European children. Given that varied genetic backgrounds across different ethnicity may result in different association, it is necessary to study these associations in a different ethnic population. Methods: A total of 3,922 children, including 2,191 normal-weight, 873 overweight and 858 obese children, from three independent studies were included in the study. Logistic and linear regressions were performed, and meta-analyses were conducted to assess the associations between the SNPs and obesity-related phenotypes. Results: The pooled odds ratios of the A-allele of rs564343 in PACS1 for obesity and severe obesity were 1.180 (p = 0.03) and 1.312 (p = 0.004), respectively. We also found that rs564343 was nominally associated with BMI, BMI standard deviation score (BMI-SDS), waist circumference, and waist-to-height ratio (p < 0.05). Conclusions: We showed for the first time that the rs564343 in PACS1 was associated with risk of severe obesity in a non-European population. This SNP was also found to be associated with common obesity and various obesity-related phenotypes in Chinese children, which had not been reported in the original study. The results demonstrated the value of conducting genetic researches in populations with different ethnicity.