Search Results (296)

The overall prevalence of dyslipidemia among adults continues to rise. However, limited attention has been devoted to the association between free sugar intake and dyslipidemia. This study aimed to explore the association between free sugar intake and dyslipidemia, as well as its subtypes, in Chinese adults. A total of 38,656 adults from the Chinese Food Consumption Survey (CFCS) and 3974 from the China Health and Nutrition Survey (CHNS) were included in the final analysis. Dietary intake data were collected by 24 h dietary recalls and the weighing of household foods and condiments. For the CHNS, multivariable Cox proportional hazards regression models were used to examine the association between free sugar intake and the risk of dyslipidemia and its subtypes. Restricted cubic spline (RCS) regression was used to evaluate the nonlinear relationship between free sugar intake and dyslipidemia. Stratified analyses and interaction tests were performed across key covariates to explore potential effect modifiers of the association between free sugar intake and dyslipidemia risk. For the CFCS, the mean free sugar intake among Chinese adults was 6.4 g/d. For the CHNS, a total of 1052 individuals were diagnosed with dyslipidemia, corresponding to an incidence rate of 26.5% during a total of 24,531 person-years of follow-up (median follow-up, 6.0 years) in the CHNS cohort. After multivariable adjustment, the risk of dyslipidemia was increased by 38% with >20 g/d free sugar intake (HR = 1.38, 95% CI: 1.04–1.84, p for trend = 0.006), with <5 g/d free sugar intake as a reference. For different subtypes of dyslipidemia, with <5 g/d free sugar intake as a reference, the risk of hypo-HDL-cholesterolemia and hyper-LDL-cholesterolemia was increased by 91% (HR = 1.91, 95% CI: 1.34–2.74, p for trend < 0.001) and 52% (HR = 1.52, 95% CI: 1.01–2.29, p for trend = 0.004) with > 20g/d free sugar intake, respectively. Stratified analyses demonstrated that the impact of high free sugar intake on the development of hypo-HDL-cholesterolemia and hyper-LDL-cholesterolemia was significantly amplified among urban residents and those with insufficient physical activity. While linear dose–response associations were observed between free sugar intake and the risk of dyslipidemia (p for nonlinearity > 0.05), a nonlinear, inverted U-shaped association emerged for hyper-LDL-cholesterolemia (p for nonlinearity = 0.007). Our study demonstrates that free sugar intake levels in Chinese adults were relatively low compared to the recommended intake level (<50 g/d) in the Chinese Dietary Guidelines 2022. Nevertheless, increased free sugar intake was positively associated with a higher risk of incident dyslipidemia, as well as incident hypo-HDL-cholesterolemia and hyper-LDL-cholesterolemia. Targeted nutrition education is recommended to promote balanced dietary patterns and enhance overall dietary quality, thereby effectively reducing the risk of dyslipidemia. Full article

Background: Long-term fluctuations in body weight may reflect changes in energy balance, illness, or intentional weight loss. However, their association with subsequent triglyceride concentrations remains uncertain. Objective: To examine the association between long-term weight variability and subsequent triglyceride concentrations while accounting for directional weight change. We also assessed the robustness of the findings to adjustment for adiposity, missing data, and socioeconomic and lifestyle covariates. Methods: We analyzed adults from the China Health and Nutrition Survey who had at least three measured weights during 1989–2006 and a triglyceride measurement in 2009. The core complete-case analysis included 5191 participants and adjusted for baseline age, sex, weight slope, number of weight measurements, and working status in 2009. Weight variability was assessed using the coefficient of variation (CV; per 1 SD increment, standardized among 9500 eligible participants) and average successive variability (ASV; per 5 kg increment). Results: In the core model, each 1 SD increment in CV was associated with 2.7% higher triglyceride concentrations (β = 0.026, 95% CI: 0.007 to 0.045; p = 0.007). Each 5 kg increment in ASV was associated with 10.7% higher triglyceride concentrations (β = 0.102, 95% CI: 0.057 to 0.147; p < 0.001). After further adjustment for baseline BMI in the same BMI-complete sample, the corresponding estimates were 3.6% (95% CI: 1.7% to 5.6%) and 5.6% (95% CI: 1.0% to 10.3%), respectively. Multiple imputation yielded similar estimates. A four-knot restricted cubic spline analysis supported an overall association between CV and triglyceride concentrations (p = 0.016), with no strong evidence of nonlinearity (p = 0.101). Marginal standardization yielded adjusted differences in arithmetic mean triglyceride concentrations of 0.048 mmol/L per 1 SD increment in CV and 0.200 mmol/L per 5 kg increment in ASV. Conclusions: Greater long-term weight variability was associated with modestly higher subsequent triglyceride concentrations. Because of the observational design, the heterogeneous causes of weight change, and the possibility of residual confounding, the findings should not be interpreted as causal or independent of obesity. Full article

Background/Objectives: Early-life undernutrition may exert lifelong and intergenerational effects on height and weight, but its impact on body shape remains unclear. Using the Great Chinese Famine (1959–1961) as a natural experiment, this study explored the associations between early-life undernutrition and body shape indices across two generations. Methods: We analyzed nine waves of longitudinal data from the China Health and Nutrition Survey (1991–2015), including 5156 participants (F1) born in 1955–1966 and their 2383 biological offspring (F2). F1 famine exposure was classified by birth year; F2 exposure was defined by parental status. Anthropometric indices including body adiposity index (BAI), body roundness index (BRI), waist-to-height ratio (WHtR), conicity index (COI), and a body shape index (ABSI) were derived from repeated measurements. Age-specific fitted curves of these indices were compared across exposure groups using mixed-effects models with fractional polynomials of age. Results: Fetal famine exposure was modestly associated with lower COI and ABSI in adulthood, particularly among men. Childhood famine exposure was significantly linked to lower BAI (−0.40), BRI (−0.26), WHtR (−0.0140), COI (−0.0188), and ABSI (−0.0008), with stronger associations in men (all P for sex interaction <0.05). Intergenerationally, maternal childhood exposure was associated with higher offspring BAI, whereas paternal childhood exposure was associated with lower BAI, BRI, WHtR, COI, and ABSI. Conclusions: Famine exposure showed more pronounced associations with body shape in men, and maternal and paternal exposures displayed different intergenerational patterns. These exploratory findings suggest the possibility that early-life undernutrition may relate to long-term phenotypes in a sex-specific manner, though this requires independent replication. Full article

Background: Unfavorable cardiovascular–kidney–metabolic (CKM) status represents a major contributor to all-cause deaths. Our study sought to investigate the joint association of functional impairment and depression with advanced CKM syndrome among individuals of middle and old age. Methods: Participants for the cross-sectional analysis were drawn from the National Health and Nutrition Examination Survey (NHANES) in the United States, while those for the cohort analysis were selected from the China Health and Retirement Longitudinal Study (CHARLS). To analyze the independent and joint associations of functional impairment, depression, and their comorbidity with advanced CKM syndrome, multivariable logistic regression was performed. Subgroup analyses were performed to evaluate effect variations and interactions. Results: In the NHANES sample, the coexistence of instrumental activities of daily living (IADL)/basic activities of daily living (BADL) impairment and depression showed a significant positive association with advanced CKM syndrome (IADL and depression: odds ratio [OR] = 4.843, 95% confidence interval [CI]: 2.505, 9.366; BADL and depression: OR = 4.394, 95% CI: 2.281, 8.464); In the CHARLS cohort, the coexistence of IADL/BADL impairment and depression showed a stronger association with advanced CKM syndrome (IADL and depression: OR = 2.259, 95% CI: 1.517, 3.319; BADL and depression: OR = 2.287, 95% CI: 1.501, 3.419). Conclusions: The presence of functional impairment and depression is significantly associated with advanced CKM syndrome. Screening for coexisting functional impairment and depression may help identify individuals who are more likely to develop advanced CKM syndrome. Full article

Background: The Nutrition Improvement Program has been implemented in China for over a decade; however, its assessment in Hubei Province has not yet been systematically reported. This study evaluated the implementation outcomes of the Rural Compulsory Education Students’ Nutrition Improvement Program in Hubei Province. Methods: A multi-stage cluster sampling design with stratification by school type was used. Standardized questionnaires were administered to schools, districts, and students to assess the food environment, nutrition policies, and dietary behaviors. Anthropometric and biochemical measurements were collected from all participants in 2014 and 2023. Results: A total of 24 schools across six counties in Hubei Province were surveyed at two time points, comprising 8619 students (4388 in 2014 and 4231 in 2023). Between 2014 and 2023, the proportion of students in the Nutrition Improvement Program reporting satisfaction with school meals increased significantly, and average nutritional knowledge scores improved. Nevertheless, several deficiencies persisted: menus remained poorly aligned with dietary guidelines, food variety was limited, full-time nutrition or health teachers were scarce, and absolute levels of nutritional knowledge remained low. In 2023, the prevalence of undernutrition, overweight/obesity, and anemia among program participants was 9.5%, 15.9%, and 12.2%, respectively. Compared with girls, boys had higher rates of undernutrition and overweight/obesity and a lower anemia rate; the same pattern was observed in primary school students relative to junior high school students. Compared with 2014, the nutritional profile shifted markedly (p < 0.001). Undernutrition and anemia declined by 7.4 and 4.9 percentage points, respectively, whereas overweight/obesity increased by 6.9 percentage points. Conclusions: From 2014 to 2023, students in the Nutrition Improvement Program of Hubei Province experienced observable changes in nutritional status: the primary nutritional concern had shifted from undernutrition to overnutrition, and the prevalence of anemia has generally decreased, while it has increased in some areas. However, given the observational nature of the repeated cross-sectional design, causal inference regarding the program’s impact was not supported. Full article

Objectives: This study aims to investigate the associations between dietary branched-chain amino acids (BCAAs) intake and appendicular skeletal muscle mass (ASM) as well as handgrip strength in Chinese adults. Methods: A total of 36,086 observations (54.32 ± 14.63 y) were included from the China Health and Nutrition Survey (CHNS) across three waves (2015, 2018, and 2022–2024). ASM was measured by bioelectrical impedance analysis, and handgrip strength was measured using a digital dynamometer. Dietary BCAA intake was assessed using three consecutive 24 h dietary recalls and adjusted for energy intake. Multilinear mixed-effect models were employed to examine the longitudinal association between BCAA intake and ASM. Multivariable regression was used to assess the cross-sectional association between BCAA intake and handgrip strength. Results: Dietary BCAA intake was significantly associated with ASM (β = 0.074, p < 0.05) with adjustment for potential confounding factors. This estimated positive effect increased with age in both males and females, and was consistently stronger in males. Compared with the lowest quintile (Q1), Q4 of dietary BCAA intake had higher handgrip strength (β = 0.721, p < 0.001). Stratified analyses showed that this association was more pronounced in males (Q4 vs. Q1: β = 1.016, p = 0.005) and in participants aged ≥65 years (Q4 vs. Q1: β = 1.024, p = 0.008). Conclusions: Dietary BCAA intake is recommended to maintain muscle mass and strength in Chinese adults. Full article

Objective: The aim of this study was to examine the association between dietary copper intake and incident metabolic syndrome (MetS) in Chinese adults. Methods: Data were obtained from the China Health and Nutrition Survey (CHNS) in 2009, 2015, and 2018. A total of 2418 adults aged 18–64 years who were free of MetS at baseline in 2009 were included. Person-period data were constructed, and discrete-time hazard models with a complementary log-log link were used to evaluate the associations of dietary copper intake with incident MetS and its components. Restricted cubic spline analysis (RCS) was used to assess the dose–response relationship. Results: After multivariable adjustment, compared with the lowest quartile (Q1) of dietary copper intake, the Q4 groups had a higher risks of incident MetS, with HR (95% CI) of 1.32 (1.06–1.65) (p = 0.014). When analyzed as a continuous variable, each 1 mg/1000 kcal increase in energy-adjusted dietary copper intake was associated with an approximately 27% higher risk of incident MetS (HR = 1.27, 95% CI: 1.03–1.53) (p = 0.023). RCS indicated a significant overall association without evidence of nonlinearity. Component analyses suggested that higher dietary copper intake might be associated with increased risks of reduced high-density lipoprotein cholesterol (HDL-C) and abdominal obesity. Sensitivity analyses were generally consistent with the main findings. Conclusions: Higher dietary copper intake was associated with an increased risk of incident MetS in Chinese adults. Component analyses suggested a more consistent association for reduced HDL-C, while an additional possible association was observed for abdominal obesity. Full article

Creating effective computer-assisted learning (CAL) environments for children remains challenging, particularly in sustaining motivation, engagement, and meaningful learning outcomes. While educational games are widely used to address these challenges, many studies rely on post hoc evaluation rather than incorporating data-driven insights into the design process. This study presents an exploratory design framework that uses clustering of educational game reviews and sentiment-informed stakeholder insights as design drivers to guide the development of a dual-format nutrition-focused learning environment. The framework integrates established learning analytics techniques, including clustering, behavioral analysis, and sentiment analysis, with pedagogical approaches such as user-centered design, gamification, and interactive learning. An illustrative evaluation was conducted using multiple data sources, including the China Nutrition and Health Survey (CHNS), 1500 educational game reviews, and a classroom-based implementation involving 120 s-grade students. All participants engaged with both board-based and computer-based formats. The analysis identified three design-relevant themes—content engagement, visual appeal, and motivational mechanisms—which were used to inform the development of the learning environments. The results suggest improvements in knowledge-related outcomes, along with observable patterns of learner engagement across interaction formats. The dual-format design was associated with specific engagement patterns, including socially mediated interaction and individual participation. These findings are interpreted as indicative rather than causal. From an educational sustainability perspective, the findings are considered in terms of engagement continuity, outcome consistency, and design adaptability. Full article

As rural residents face the dual challenges of transforming dietary structures and addressing nutritional health burdens, establishing a resilient food consumption system for rural households has become an urgent priority. Drawing on micro-level data from the China Land Economic Survey (CLES) for the period 2020–2022, this study employs two-way fixed effects models, an instrumental variable (IV) approach, and seemingly unrelated regression (SUR) techniques to examine the impact of agricultural production diversity on household food expenditure and dietary diversity, as well as the underlying mechanisms. The results reveal that agricultural production diversity yields a significant and robust dual-dividend effect within household food consumption systems: it not only reduces per capital food expenditure but also enhances dietary diversity. Mechanism analysis indicates that diversified production increases food self-sufficiency, thereby reducing cash outflows for essential food items, while simultaneously improving dietary diversity through increased agricultural income and greater agricultural commercialization. Heterogeneity analysis further shows that these effects are more pronounced in villages lacking rural industrial support and among non-ageing households. These findings suggest that, in contexts where market mechanisms remain underdeveloped, the uncritical pursuit of absolute agricultural specialization may not align with the livelihood and nutritional needs of rural residents. From the perspective of fostering a healthy and resilient food system, China should adopt differentiated agricultural support policies, encourage rural households to maintain an appropriate degree of production diversity, and strengthen local agricultural market infrastructure. Full article

Background/Objectives: Rising incomes worldwide are reshaping dietary patterns and intensifying concern about the carbon impacts of household food consumption. This study examines how economic development influences food-related carbon emissions in China, with a focus on household food consumption behavior and dietary change. Methods: Using longitudinal household data from the China Health and Nutrition Survey covering 2004–2011, we apply a panel threshold regression model to identify nonlinear income effects on food-related carbon emissions. Results: Within the 2004–2011 sample, household income is positively associated with food-related emissions, but the marginal effect declines once income exceeds the estimated threshold. The baseline model identifies a single threshold at 6.5479 (95% confidence interval: [6.4965, 6.5917]), corresponding to 65,479 yuan in annual household income. The single-threshold test is significant at the 5% level (p = 0.035), and the adjusted R² is 0.243. Income growth significantly increases the consumption of greenhouse-gas-intensive foods and associated emissions among low-income households, whereas food consumption patterns among high-income households are comparatively more stable within the sample period. Conclusions: These findings indicate that rising income can intensify food-related carbon pressure during China’s dietary transition, particularly through dietary upgrading among low-income households, but they do not provide direct evidence that household food emissions will stabilize automatically over time. Full article

Against the backdrop of increasing global emphasis on sustainable development and ecological conservation, green seafood has emerged as a key component of sustainable marine food consumption. However, the discrepancy between consumers’ intention to consume and their consumption behavior remains a critical issue requiring in-depth investigation. Herein, based on survey data collected from 415 consumers in China in 2025, this study employs structural equation modeling (SEM) to analyze the determinants and mechanisms influencing green seafood consumption intention and behavior. The findings indicate that heightened concerns regarding dietary health, food safety, and nutrition significantly enhance consumer intention, driven primarily by ecological awareness and the pursuit of a higher quality of life. Individual and household characteristics, along with consumers’ cognitive status of green seafood, exert significant positive effects on consumption intention, with cognitive status demonstrating the strongest influence. Nevertheless, a notable gap exists between consumption intention and actual behavior. Among respondents with consumption intention, only 48.7% had ever purchased green seafood, and the consumption frequency remained generally low. SEM path coefficients further reveal that marketing factors play a dominant role in actualizing consumption behavior. Compared to marketing factors, consumption intention shows a relatively weaker effect in facilitating consumption behavior. This finding further confirms the intention–behavior gap in green seafood consumption. The intention–behavior gap in green seafood consumption is jointly driven by asymmetric information on product quality, an underdeveloped certification system, a relatively undiversified supply structure, and elevated prices. Accordingly, this study proposes an integrated strategy that includes establishing a unified certification and traceability system, optimizing supply structures and pricing mechanisms, and strengthening science communication and targeted marketing. These measures aim to bridge the intention–behavior gap and promote the transition toward sustainable consumption patterns. Full article

Food and nutrition are the foundation for human survival. This study focuses on the strategic goals of a Healthy China and actively responding to population aging, empirically examining the impact effects and mechanisms of population aging on the food consumption quantity of rural residents in China. Based on a sample of 2846 rural households from 10 provinces in the China Rural Revitalization Survey (CRRS), this study employs various methods such as Ordinary Least Squares (OLS), instrumental variable methods, and mediation effect models for empirical testing. The study found that population aging has a significant positive impact on the consumption of grains, vegetables, legumes, dairy products, and eggs among rural residents in China, while showing a significant negative impact on the consumption of beef/lamb and fruits. For every 1 percentage point increase in the proportion of individuals aged 60 and above in a household, the consumption of grains, vegetables, legumes, dairy products, and eggs increased by an average of 106.857 g/day, 57.900 g/day, 8.202 g/day, 9.226 g/day, and 7.116 g/day, respectively. The consumption of beef/lamb and fruits decreased by an average of 5.585 g/day and 36.316 g/day, respectively. Although population aging has led to a decrease in the consumption of certain food items among rural residents, the increase in grain consumption has resulted in an enhanced total energy intake per capita for households. Household income levels and the scale of land management play important mediating roles in the impact of population aging on the quantity of food consumed by rural residents. Therefore, corresponding countermeasures are proposed, aiming to promote the construction of a food consumption monitoring system in China, broaden income channels for rural residents, systematically carry out nutrition and health education, and improve the rural social security system in China, thereby optimizing the structure of food consumption. Full article

Background: Noncommunicable diseases (NCDs) are a major global public health challenge and can be prevented and managed through a balanced, nutrient-rich diet. Food nutrition labels play an important role in guiding healthier choices, particularly for individuals at risk of chronic health conditions. This study assessed awareness, understanding and use of nutrition labels among adults in Shanghai, China, and explored their associations with NCDs. Methods: A face-to-face structured questionnaire survey was conducted among 1503 adults in 2024. Data were collected on sociodemographic characteristics, self-reported chronic conditions (obesity, diabetes, hypertension, hyperlipidemia, hypercholesterolemia, cardiovascular and cerebrovascular diseases (CCVDs), and fatty liver disease), and awareness, understanding, and use of nutrition labels. Generalized linear regression models were applied to assess associations between label-related behaviors and chronic conditions. Results: Overall, 81.6% of participants were aware of labels, 15.0% reported understanding them, and 35.5% reported using them. Participants who were underweight or obese were less likely to be aware of labels compared to those with normal weight (73.8% and 72.9% vs. 83.5%). Individuals with fatty liver disease were less likely to understand labels compared to those without the condition (7.2% vs. 16.1%). Conversely, participants with three or more chronic conditions were more likely to use labels than those without any chronic conditions (46.1% vs. 34.4%). Conclusions: Among adults in Shanghai, nutrition label awareness was relatively high, while understanding and use of labels remained insufficient. Targeted nutrition education and the integration of nutrition labeling into chronic disease management strategies are needed to improve public health outcomes. Full article

Background/Objectives: Current evidence on the diabetes prevention benefit of substituting red meat with white meat remains inconsistent and is predominantly based on Western populations. This research examined whether the benefits of such dietary substitution depend on habitual red meat intake levels. Methods: This prospective analysis included 12,143 adults from the China Health and Nutrition Survey (2004–2015). Dietary intake was assessed by multiple 24 h recalls supplemented by a household food inventory. Incident diabetes was identified via self-report and supplementary biochemical data. Estimates of hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained through Cox proportional hazards modeling. Dose–response relationships were examined using restricted cubic splines. Substitution effects were evaluated within strata defined by baseline red meat intake (<75 vs. ≥75 g/day). Results: During 83,046 person-years of follow-up, 687 incident diabetes cases occurred. U-shaped associations were identified for both red meat (lowest risk at 75 g/day) and white meat (lowest risk at 60 g/day) consumption in relation to diabetes risk (p-nonlinearity < 0.0001). Substitution was not associated with diabetes risk in the low-intake stratum (<75 g/day, p = 0.107). Conversely, in the high-intake stratum (≥75 g/day), replacing 50 g/day of red meat with white meat was associated with a 34% lower diabetes risk (HR: 0.66; 95% CI: 0.51, 0.86; p = 0.002). Conclusions: Meat intake shows a nonlinear association with diabetes risk in Chinese adults. The potential benefit of substituting white meat for red meat is conditional, with a more pronounced effect observed among individuals with high habitual red meat consumption, which may support the development of targeted dietary guidance for this subgroup. Full article

Background/Objectives: Socioeconomic status (SES) and health insurance are critical determinants of chronic disease outcomes. This study evaluates their impact on the hypertension and diabetes “care cascade” (diagnosis, treatment, and control) across three distinct health systems: China, the United States (US), and the United Kingdom (UK). Methods: We analyzed cross-sectional data from pooled survey waves of the China Health and Retirement Longitudinal Study (CHARLS), the US National Health and Nutrition Examination Survey (NHANES), and the English Longitudinal Study of Ageing (ELSA). The final analytic sample comprised a total of 46,054 participants with hypertension and 11,805 with diabetes. Logistic regression model was employed to estimate the associations of education, wealth, and health insurance with disease management outcomes. Results: Significant cross-national heterogeneity was observed. China exhibited the steepest attrition in the care cascade, with disparities strongly linked to insurance fragmentation; notably, Urban Employee Insurance was associated with significantly better outcomes compared to the Rural Cooperative Medical Scheme. In the US, health insurance was strongly associated with diagnosis and treatment initiation but showed attenuated associations with disease control, suggesting that financial barriers (“underinsurance”) may persist. The UK demonstrated the highest equity in access due to universal National Health Service coverage, though education remained a predictor for diabetes identification; moreover, a persistent wealth-based gradient in disease control remained despite universal access. Conclusions: Universal health coverage effectively mitigates access barriers but does not eliminate inequalities driven by cumulative socioeconomic disadvantage. Achieving equity requires context-specific strategies: reducing insurance fragmentation in China, minimizing out-of-pocket costs in the US, and addressing upstream social determinants in the UK. Full article