Yuna He

Exposure to the Chinese Famine in Early Life and the Risk of Hyperglycemia and Type 2 Diabetes in Adulthood

OBJECTIVE Early developmental adaptations in response to undernutrition may play an essential role in susceptibility to type 2 diabetes, particularly for those experiencing a “mismatched rich nutritional environment” in later life. We examined the associations of exposure to the Chinese famine (1959–1961) during fetal life and childhood with the risk of hyperglycemia and type 2 diabetes in adulthood. RESEARCH DESIGN AND METHODS We used the data for 7,874 rural adults born between 1954 and 1964 in selected communities from the cross-sectional 2002 China National Nutrition and Health Survey. Hyperglycemia was defined as fasting plasma glucose ≥6.1 mmol/l and/or 2-h plasma glucose ≥7.8 mmol/l and/or a previous clinical diagnosis of type 2 diabetes. RESULTS Prevalences of hyperglycemia among adults in nonexposed, fetal exposed, early-childhood, mid-childhood, and late-childhood exposed cohorts were 2.4%, 5.7%, 3.9%, 3.4%, and 5.9%, respectively. In severely affected famine areas, fetal-exposed subjects had an increased risk of hyperglycemia compared with nonexposed subjects (odds ratio = 3.92; 95% CI: 1.64–9.39; P = 0.002); this difference was not observed in less severely affected famine areas (odds ratio = 0.57; 95% CI: 0.25–1.31; P = 0.185). The odds ratios were significantly different between groups from the severe and less severe famine areas (P for interaction = 0.001). In severely affected famine areas, fetal-exposed subjects who followed an affluent/Western dietary pattern (odds ratios = 7.63; 95% CI: 2.41–24.1; P = 0.0005) or who had a higher economic status in later life experienced a substantially elevated risk of hyperglycemia (odds ratios = 6.20; 95% CI: 2.08–18.5; P = 0.001). CONCLUSIONS Fetal exposure to the severe Chinese famine increases the risk of hyperglycemia in adulthood. This association appears to be exacerbated by a nutritionally rich environment in later life.

Exposure to the Chinese Famine in Early Life and the Risk of Metabolic Syndrome in Adulthood

OBJECTIVE To examine whether exposure to the Chinese famine during fetal life and early childhood is associated with the risks of metabolic syndrome and whether this association is modified by later life environment. RESEARCH DESIGN AND METHODS We used data of 7,874 adults born between 1954 and 1964 from the 2002 China National Nutrition and Health Survey. Famine exposure groups were defined as nonexposed; fetal exposed; and early childhood, midchildhood, or late childhood exposed. Excess death rate was used to determine the severity of the famine. The ATP III criteria were used for the definition of metabolic syndrome (three or more of the following variables: elevated fasting triglyceride levels, lower HDL cholesterol levels, elevated fasting glucose levels, higher waist circumference, high blood pressure). RESULTS In severely affected famine areas, adults who were exposed to the famine during fetal life had a higher risk of metabolic syndrome, as compared with nonexposed subjects (odds ratio 3.13 [95% CI 1.24–7.89, P = 0.016]). Similar associations were observed among adults who were exposed to the famine during early childhood, but not for adults exposed to the famine during mid- or late childhood. Participants who were born in severely affected famine areas and had Western dietary habits in adulthood or were overweight in adulthood had a particularly high risk of metabolic syndrome in later life. CONCLUSIONS Exposure to the Chinese famine during fetal life or infancy is associated with an increased risk of metabolic syndrome in adulthood. These associations are stronger among subjects with a Western dietary pattern or who were overweight in adulthood.

Determinants of childhood overweight and obesity in China

In order to investigate the determinants of childhood overweight and obesity in China, the prevalence of overweight (including obesity) was compared according to different dietary and physical activity patterns and parental body weight status. A total of 6826 children aged 7-17 years from the 2002 China National Nutrition and Health Survey were included in the study. Information for dietary intake was collected using three consecutive 24-h recalls by trained interviewers. The amounts of cooking oil and condiments consumed were weighed. An interview-administered 1-year physical activity questionnaire was used to collect physical activity information. The results showed that the heavier the parental bodyweight, the higher the overweight prevalence in children. The prevalence ratio increased if parent(s) were overweight and/or obese, up to 12.2 if both parents were obese. Overweight children consumed significantly more dietary energy, protein and fat, but less carbohydrate than their normal weight counterparts. On average, overweight children spent 0.5 h less on moderate/vigorous activities and 2.3 h more on low intensity activities per week. The following prevalence ratios were statistically significant: walking to and from school (0.6); moderate/vigorous activities > or =45 min/d (0.8); low intensity physical activities >2 h/d (1.3); the consumption of > or =25 g/d cooking oil (1.4); > or =200 g/d meat and meat products consumption (1.5); > or =100g/d dairy products (1.8). After adjustment for parental body weight status and socioeconomic status, only cooking oil consumption and walking to and from school remained significantly related to child overweight. In conclusion, parental weight status is an import-ant determinant. Fat intake, low intensity activities and active transport to/from school may be suitable entry points for overweight prevention among Chinese school children.

Dietary patterns and glucose tolerance abnormalities in Chinese adults.

OBJECTIVE To investigate the association of the dietary pattern with the presence of newly diagnosed glucose tolerance abnormalities among Chinese adults. RESEARCH DESIGN AND METHODS A total of 20,210 adults aged 45–69 years from the 2002 China National Nutrition and Health Survey were included. Information on dietary intake was collected using a validated food frequency questionnaire. Factor analysis and cluster analysis were used to identify the food factors and dietary pattern clusters. RESULTS Four dietary pattern clusters were identified (“Green Water,” “Yellow Earth,” “Western Adopter,” and “New Affluence”). The prevalence of glucose tolerance abnormalities ranged from 3.9% in the Green Water to 8.0% in the New Affluence. After adjustment for area, age, sex, current smoking, and physical activity, subjects in the Yellow Earth cluster (prevalence ratio 1.22 [95% CI 1.04–1.43]) and New Affluence cluster (2.05 [1.76–2.37]) had significantly higher prevalence rates compared with those for the Green Water cluster. After further adjustment for BMI and waist-to-height ratio, the elevated risk in the New Affluence remained statistically significant. CONCLUSIONS Dietary patterns and food factors are associated with the presence of glucose tolerance abnormalities in China, even independent of obesity. A New Affluence diet is an important modifiable risk factor, which needs attention from the prevention point of view.

Abdominal obesity and the prevalence of diabetes and intermediate hyperglycaemia in Chinese adults

OBJECTIVE To assess the association of indicators of general and abdominal obesity with the prevalence of type 2 diabetes (T2DM) and intermediate hyperglycaemia (IHG) in the Chinese population. METHODS We used data of 50 905 adults aged 18-79 years in the 2002 China National Nutrition and Health Survey. Recommended Chinese cut-off values were used for BMI (24 kg/m2) and waist circumference (WC; 85 cm in men, 80 cm in women). Optimal cut-offs for waist:height ratio (WHtR) were determined from analyses of receiver-operating characteristic (ROC) curves. RESULTS The prevalence of T2DM and IHG was 2.6 % and 1.9 % respectively. ROC curve analyses indicated 0.5 as the optimal cut-off value for WHtR in both sexes. High BMI, WC and WHtR were all associated with the prevalence of glucose tolerance abnormalities, with the highest prevalence ratio (PR) for high WHtR (men: PR = 2.85, 95 % CI 2.54, 3.21; women: PR = 3.10, 95 % CI 2.74, 3.51). When combining BMI and WHtR, in men either a high BMI or a high WHtR alone was associated with increased risk. Among women, a high BMI without a concomitant high WHtR was not associated with increased glucose tolerance abnormalities risk, whereas a high WHtR was associated with risk irrespective of BMI. CONCLUSIONS Among the Chinese adult population measures of central obesity are better predictors of glucose tolerance abnormalities prevalence than BMI. A WHtR cut-off point of 0.5 for both men and women can be considered as optimum for predicting (pre-) diabetes and may be a useful tool for screening and health education.

Exposure to the Chinese famine in early life and the risk of hypertension in adulthood

Objectives Maternal famine exposure has been associated with higher blood pressure in the offspring. The aim of the present study was to examine the associations of early life exposure to the 1959–1961 Chinese famine with the risk of hypertension in later life, and to examine whether a nutritional ‘rich’ environment in later life modifies this association. Methods We used data of 7874 adults born between 1954 and 1964 from the 2002 China National Nutrition and Health Survey. Excess death rate was used to determine the severity of the famine. Results In severely affected famine areas, as compared to adults who were not exposed to famine, those exposed during fetal life had a significantly higher SBP [SBP difference 2.2 mmHg, 95% confidence interval (CI) 1.3–3.0, P < 0.0001], DBP (DBP difference 0.9 mmHg, 95% CI 0.3–1.5, P = 0.003) and a marginally higher risk of hypertension (odds ratio 1.88, 95% CI 1.00–3.53, P = 0.05), after adjustment of age, sex, socioeconomic status, lifestyle, dietary factors and family history of hypertension, which was not observed in less severely affected famine areas (P for interaction was 0.08 for SBP, 0.03 for DBP and 0.03 for hypertension). These associations were more pronounced in participants who had a western dietary pattern or who were overweight as adult. Conclusion Our results suggest that fetal famine exposure is associated with higher blood pressure and an increased risk of hypertension in adulthood. These associations are stronger in participants who have a western dietary pattern or who are overweight as adults.

Dietary Patterns Are Associated with Stroke in Chinese Adults

We recently featured Chinese dietary patterns that were associated with obesity, hyperglycemia, hypertension, and metabolic syndrome. In this study, we examined the association of those dietary patterns and risk of stroke among 26,276 Chinese adults aged ≥45 y by using data from the 2002 China National Nutrition and Health Survey and explored whether those associations were mediated by obesity, hypertension, hyperglycemia, and other cardiovascular risk factors. The traditional southern Chinese dietary pattern, characterized by high intakes of rice and vegetables and moderate intakes in animal foods, was related to the lowest prevalence of stroke. Compared to the traditional southern dietary pattern, the traditional northern Chinese dietary pattern, characterized by high intakes of refined cereal products, potatoes, and salted vegetables, was associated with an elevated risk of stroke [OR = 1.96 (95% CI = 1.48-2.60); P < 0.0001]. Adjustment for conventional cardiovascular risk factors did not appreciably change the association [multivariate adjusted OR = 1.59 (95%CI = 1.16-2.17); P = 0.004]. The Western dietary pattern characterized by high consumption of beef, fruit, eggs, poultry, and seafood is also associated with an elevated risk of stroke [OR = 2.36 (95%CI = 1.82-3.06); P < 0.0001], but the associations became nonsignificant after adjustment for obesity, hypertension, hyperglycemia, and dyslipidemia. In conclusion, we found that the traditional southern dietary pattern was related to low prevalence of stroke and the traditional northern dietary pattern was associated with an increased stroke risk. The Western dietary patterns also association with high risk of stroke, which was largely mediated by obesity, hypertension, hyperglycemia, and dyslipidemia.

Lack of dietary diversity and dyslipidaemia among stunted overweight children: the 2002 China National Nutrition and Health Survey

OBJECTIVE Both stunting and overweight are present in children across China. Seemingly paradoxical, these two conditions can also coexist in the same child. The aim was to examine the associations between dietary food/nutrient intake and plasma lipid profiles related to stunting and overweight status. DESIGN The 2002 China National Nutrition and Health Survey was a family-based nationally representative cross-sectional study. SETTING Thirty-one provinces, autonomous regions and municipalities. SUBJECTS The study included 13,770 children aged 2-17 years. The sample size for the four exposure groups was 10,814 for children of normal height and weight, 2128 for stunted, 729 for overweight and 99 for stunted overweight. RESULTS Compared with children of normal height and weight, stunted and stunted overweight children consumed more high-energy-dense foods with a lower dietary diversity score, less protein, polyunsaturated fat and Fe, and a higher molar ratio of phytate to Ca. On the contrary, overweight children tended to consume significantly less carbohydrates and more protein and fat. Overall, stunted overweight children consumed lower amounts of vegetables, fruit, white meat (poultry and fish) and more milk. The OR for prevalent dyslipidaemia were 1·32 (95% CI 1·13, 1·53), 1·76 (95% CI 1·48, 2·09) and 2·59 (95% CI 1·65, 4·07) among stunted, overweight and stunted overweight children, respectively, compared with children of normal height and weight. In addition, being overweight was significantly associated with high glucose concentrations, whereas stunting was significantly associated with having anaemia. CONCLUSIONS Limited dietary diversity and intake of high-energy-dense foods were notably observed among stunted overweight children. Furthermore, being stunted and/or overweight was associated with an increased likelihood of unhealthy lipid profiles.

Geographic variation in the prevalence of overweight and economic status in Chinese adults

China is experiencing a rapid increase in overweight and related conditions. This study describes the geographic variation in BMI levels and the prevalence of overweight and underweight in Chinese adults, and assesses their relations with regional Gross Domestic Product (GDP) per capita levels. BMI values and the prevalence of overweight and underweight in 143 522 adults from the Chinese National Nutrition and Health Survey (2002) were calculated according to geographic regions in China. Their correlations with GDP were assessed. Linear and logistic regressions were used to adjust for age, sex and city-country composition. BMI and the prevalence of overweight were highest in the Bohai coastal regions while lowest in southern provinces such as Guangdong, Guangxi, Yunnan, Hunan and Fujian. Mean BMI values ranged from 20.72 to 25.48 kg/m2, and the prevalence of overweight ranged from 6.6 to 53.9 %. BMI and the prevalence of overweight were positively correlated with economic development, particularly in the northern regions. However, for regions with similar GDP per capita levels, those in the south had substantially lower BMI and lower prevalence of overweight than those in the north. Interestingly, some southern regions with high GDP per capita had low BMI and low prevalence of overweight. The prevalence of underweight was highest in the south. Substantial geographic variations in the prevalence of overweight and underweight exist in China. Such variations cannot be fully explained by the differences in economic status. China is currently facing challenges of both overweight and underweight but priorities vary in different regions.

Joint Association of Dietary Pattern and Physical Activity Level with Cardiovascular Disease Risk Factors among Chinese Men: A Cross-Sectional Study.

The purpose of this cross-sectional study was to investigate the joint associations of physical activity level (PAL) and dietary patterns in relation to cardiovascular disease (CVD) risk factors among Chinese men. The study population consisted of 13 511 Chinese males aged 18–59 years from the 2002 China National Nutrition and Health Survey. Based on dietary data collected by a food frequency questionnaire, four dietary patterns were identified and labeled as “Green Water” (high consumption of rice, vegetables, seafood, pork, and poultry), “Yellow Earth” (high consumption of wheat flour products and starchy tubers), “New Affluent” (high consumption of animal sourced foods and soybean products), and “Western Adopter” (high consumption of animal sourced foods, cakes, and soft drinks). From the information collected by a 1-year physical activity questionnaire, PAL was calculated and classified into 4 categories: sedentary, low active, active, and very active. As compared with their counterparts from the New Affluent pattern, participants who followed the Green Water pattern had a lower likelihood of abdominal obesity (AO; 50.2%), hypertension (HT; 37.9%), hyperglycemia (HG; 41.5%), elevated triglyceride (ETG; 14.5%), low HDL (LHDL; 39.8%), and metabolic syndrome (MS; 51.9%). When compared to sedentary participants, the odds ratio of participants with very active PAL was 0.62 for AO, 0.85 for HT, 0.71 for HG, 0.76 for ETG, 0.74 for LHDL, and 0.58 for MS. Individuals who followed both very active PAL and the Green Water pattern had a lower likelihood of CVD risk factors (AO: 65.8%, HT: 39.1%, HG: 57.4%, ETG: 35.4%, LHDL: 56.1%, and MS: 75.0%), compared to their counterparts who followed both sedentary PAL and the New Affluent pattern. In addition, adherence to both healthy dietary pattern and very active PAL presented a remarkable potential for CVD risk factor prevention.