Analysis of the Correlation between Meal Frequency and Obesity among Chinese Adults Aged 18–59 Years in 2015

This study aimed to investigate the relationship between meal frequency and obesity in Chinese adults aged 18 to 59 years. The data came from the 2015 Chinese Adult Chronic Disease and Nutrition Surveillance (CACDNS 2015) and provincial dietary environment data from the 2015 National Statistical Yearbook. A total of 34,206 adults aged 18 to 59 who took part in the diet survey were selected as the study participants. A two-level multivariate logistic regression model was used to adjust for the socioeconomic and nutritional status of individuals. For parameter estimation, a numerical integral approach was used to analyze the relationship between meal frequency (including meals at home, the workplace or school dining halls, and eating away from home) and obesity. A two-level “provincial–individual” logistic multivariate regression analysis was performed with obesity as the dependent variable. The two-level multivariate analysis of variance model fitting results showed that after adjusting for the effects of gender, age, occupation, education, marital status, family per capita annual income, provincial gross domestic product (GDP), restaurant industry turnover, consumer price index of EAFH food, and energy intake, the frequency of eating at home was not associated with obesity (all p > 0.05); the frequency of eating at dining halls ≥1 to <2 times per day (OR = 0.784, p = 0.0122) showed a negative association with obesity; the frequency of eating away from home < 1 times per day and ≥1 to <2 times per day were positively correlated with obesity (<1 time per day: OR = 1.123, p = 0.0419; ≥1 to <2 times per day: OR = 1.249, p = 0.0022). The results of the two-level random-intercept logistic multivariate mixed-effects prediction model for obesity in adults aged 18 to 59 years showed that no statistical association was noticed between the frequency of eating at home and obesity in adults aged 18 to 59 years. However, adults who ate out < 1 time and ≥1 to <2 times a day showed higher risks of obesity than those who did not eat out, with OR = 1.131 (95% CI 1.012–1.264) and OR = 1.258 (95% CI 1.099–1.440), while adults who ate at school and workplace dining halls ≥1 to <2 times a day may have a reduced risk of obesity, with OR = 0.790 (95% CI 0.656–0.951). This result could not be found based on the definition of eating out in previous studies. Therefore, it is recommended to exclude nonprofit collective canteens such as school and workplace dining halls from the definition of eating away from home, and to redefine eating out in terms of health effects. At the same time, it is also recommended to strengthen collective nutritional interventions around canteens, improve the nutritious meal system in school and workplace canteens, and create healthy canteens

The Status of Dietary Energy and Nutrients Intakes among Chinese Elderly Aged 80 and Above: Data from the CACDNS 2015

This study analyzed the status of dietary energy and nutrients intakes among the oldest-old in China. Data was obtained from the China Adult Chronic Disease and Nutrition Surveillance in 2015 (CACDNS 2015). We enrolled 1929 Chinese elderly people aged 80 and above who participated in both 3-day 24-h dietary recalls and household condiments weighing. The dietary intakes were calculated based on Chinese Food Composition Tables and assessed using Chinese Dietary Reference Intakes (DRIs). The dietary intakes of energy and most nutrients were all below the EAR or AI, except for fat, vitamin E, niacin, iron and sodium. As a result, daily dietary intakes of energy and most nutrients were inadequate in the oldest-old in China, especially vitamin A, vitamin B1, vitamin B2, folate and calcium, with the prevalence of deficiency more than 90%. Furthermore, the prevalence of inadequacy of vitamin C, zinc, selenium and magnesium was also high with the proportion below the EAR more than 60%. Approximately 30% of the subjects with dietary vitamin E intake did not reach AI, and more than 90% of subjects have reached AI in the intake of sodium, while more than 90% did not reach AI in potassium. The mean intakes of niacin and iron have reached EAR, but around 15% were still faced with the risk of deficiency. In addition, although the dietary energy intake was below EER, the energy contribution from fat in total population and all subgroups (region, age, gender, education level, material status, household income level groups) all exceeded the recommended proportion of 30% from the DRIs and close to or over 35%, is a significant concern. For the majority of nutrients, higher daily dietary intakes and lower prevalence of deficiencies were found in the oldest-old living in urban areas, aged 80–84 years, with high school and above education level, living with spouse and from high household income family. These findings indicates that the dietary intakes of energy and nutrients were inadequate, while the energy contribution from fat and dietary sodium intake were too high among the oldest-old in China. Most oldest-old were at high risk of nutritional deficiency, particularly for those who living in rural areas, with lower education level and from low household income

Validation of the MSM and NCI Method for Estimating the Usual Intake of Nutrients and Food According to Four Seasons of Seven Consecutive Daily 24 Hour Dietary Recalls in Chinese Adults

The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method are used to estimate usual dietary intake from short-term dietary assessment instruments, such as 24 hour dietary recall (24-HRs). However, their performance has not been validated in the Chinese population via nutrition surveys. To validate the accuracy of the MSM and NCI method in estimating usual dietary intake in the Chinese population, 752 individuals from northern and southern China answered four seasons of seven consecutive 24-HRs (one for each season). The true usual dietary intake was considered as the average of the 28 collection days of dietary component intake. Using data sets with consecutive 3 collection days, the usual intakes of the selected dietary components were estimated by MSM, NCI and the within-person mean of three 24-HRs (3 day method). These estimates were compared with the true usual intake at the group and individual level. At the group level, the MSM and NCI method performed similarly, yielding estimates closer to the true usual intake than 3 day method. The percentage differences of the estimates for dietary components not consumed daily from the MSM and NCI method were larger than for the dietary components consumed daily. However, the larger percentage differences were observed in the tail of the usual intake distribution. In general, dietary components with larger variance ratios had greater percentage differences. At the individual level, for overall seasons and dietary components, the biases of individual usual intake did agree for MSM and NCI method, whereas NCI method estimates were closer to true intakes than for the MSM and 3 day method. Similar results were observed in the relative biases of dietary components consumed daily. As with the group level, there was less percentage difference in dietary components consumed daily. Both the MSM and NCI method can be used to estimate usual intake in Chinese populations and are closer to the true usual intake than the traditional mean method, at both group and individual levels

Comparison of Several Adiposity Indexes in Predicting Hypertension among Chinese Adults: Data from China Nutrition and Health Surveillance (2015–2017)

The current study is to explore the association of the Chinese visceral adiposity index (CVAI) with hypertension, and to compare the predictive power of different adiposity indexes regarding hypertension among Chinese adults aged over 45 years. A total of 99,201 participants aged over 45 years from the China Nutrition and Health Surveillance 2015–2017 were included in this study. Multivariate adjusted logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of hypertension. Multivariate adjusted restricted cubic spline analyses were applied to explore the association of adiposity indexes with hypertension. Receiver operating characteristic (ROC) analyses were used to compare the predictive powers of different adiposity indexes of hypertension. All eight adiposity indexes included in this study were positively associated with hypertension. Compared with those in the lowest quartile of the CVAI, the participants in the highest quartile showed a significantly higher risk of hypertension (OR = 3.70, 95% CI = 3.54–3.86) after multiple adjustments. The ROC analyses suggested that the CVAI was the strongest predictor of hypertension compared to other adiposity indexes in both genders. The findings supported that the CVAI could serve as a reliable and cost-effective method for early identifying hypertension risk

Association between Early Life Famine Exposure and Metabolic Syndrome in Adulthood

To analyze the relationship between famine exposure at different stages of early life and the risk of developing metabolic syndrome (MetS) in adulthood, 11,865 study participants from the 2015 Chinese Adult Chronic Disease and Nutrition Surveillance Program were enrolled and then divided into a non-exposed group, fetal exposure group, early childhood exposure group, middle childhood exposure group and late childhood exposure group according to their birth time and famine exposure. MetS was defined by the NCEP ATP III criteria. Using logistic regression to explore the association between famine exposure at different stages of early life and the increased risk of developing MetS in adulthood. After adjusting other factors, compared with the non-exposure group, famine exposure during the fetal period (OR = 1.23, 95% CI = 1.00–1.51), early childhood (OR = 1.44, 95% CI = 1.11–1.87), middle childhood (OR = 1.50, 95% CI = 1.13–1.99) and late childhood (OR = 1.67, 95% CI = 1.21–2.30) had a higher risk of developing MetS in adulthood. Stratified analysis found an association between early life famine exposure and the increased risk of MetS in adulthood in females, overweight or obese participants and those who lived in areas of severe famine, in city areas and in southern China. Compared with the non-exposed group, the fetal, early childhood, middle childhood and late childhood famine-exposed groups are more likely to suffer from MetS in adulthood, especially the subjects who are females, overweight or obese and had lived in severe famine areas, city areas and southern China

Usual Intake of Micronutrients and Prevalence of Inadequate Intake among Chinese Adults: Data from CNHS 2015–2017

Previous studies have used the traditional average-value method to calculate the usual dietary intake of a population, but the results may be biased due to the measurement errors. The aim of this study was to provide an assessment of the usual micronutrient intake and estimate the prevalence of inadequate intake among Chinese adults. Data from the Chinese Nutrition and Health Surveillance 2015–2017 as well as a total of 72,231 subjects aged 18 years and older were included in the analysis. The 24 h recall method combined with the condiment weighing method were used for three consecutive days to collect daily food and condiments intake. The daily intake of 16 micronutrients was calculated based on the Chinese Food Component Tables. The National Cancer Institute (NCI) method was used to estimate the usual intake of micronutrients, and the prevalence of inadequate intake was estimated using the estimated average requirement (EAR) cut-point method. The results showed that, except for sodium, copper, iron (only for males), vitamin E, and phosphorus, the usual intake of micronutrients in Chinese adults was low, and the prevalence of inadequate intake ranged from 38.67 to 97.63%. The prevalence of inadequate calcium and riboflavin intake was more than 90%, and the proportion of individuals with a usual intake of thiamine, vitamin A, potassium, and selenium below EAR also reached 80%. Manganese, magnesium, vitamin C, and zinc were potentially deficient micronutrients, with the prevalence of inadequate intake ranging from 38.67% to 77.09%. However, usual sodium intake was extremely high with an average of 5139.61 mg/day, and only a quarter of Chinese adults were below the World Health Organization (WHO) recommended value. For most micronutrients, the usual dietary intake declined with age and the prevalence of inadequate intake increased with age. Except for zinc, vitamin A, and B-vitamins, the prevalence of micronutrient deficiencies was higher in females than in males in the same age group (p < 0.05). Therefore, Chinese adults do not receive enough micronutrients. Effective nutrition supplementary strategies and measures are needed to address these problems

Nutrient Patterns and Its Association and Metabolic Syndrome among Chinese Children and Adolescents Aged 7–17

This study was designed to explore the associations between nutrient patterns (NPs) and metabolic syndrome (MetS) and its five components among Chinese children and adolescents aged 7–17. The required data of participants were collected from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017. Ultimately, 13,071 participants were included. Nutrient patterns were obtained by means of factor analysis. Multivariate logistic regression analysis was conducted to evaluate the association between nutrient patterns with MetS and its components. After adjusting covariates, the results of logistic regression models revealed that high-carbohydrate patterns were associated with the presence of abdominal obesity. The high-animal protein pattern was negatively associated with high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C). The high-sodium-and-fat pattern had a negative relationship with elevated blood pressure (BP) and was positively associated with low HDL-C. The high-Vitamin D-and-Vitamin B12 pattern had protective effects on MetS, high TG, and low HDL-C. Further large-scale longitudinal investigations are necessary in the future

Dietary Micronutrient Status and Relation between Micronutrient Intakes and Overweight and Obesity among Non-Pregnant and Non-Lactating Women Aged 18 to 49 in China

Women between the ages of 18 and 49 are women of reproductive age, for whom physical health and nutritional status are closely related to successful pregnancy, good pregnancy outcomes and the nurturing of the next generation. Overweight and obesity have become important nutrition and health problems of women aged 18–49 years in China. In social life, non-pregnant and non-lactating Chinese women aged 18–49 are the most vulnerable and neglected group. At present, there are no research data on their dietary micronutrient intake, and the relationship between dietary micronutrient intake and overweight and obesity in China. However, non-pregnant and non-lactating women aged 18–49 are the best window of opportunity to implement strategies, correct nutrition and improve physical health. It remains to be explored whether their overweight and obesity are related to inadequate dietary micronutrient intake. The aim of this study was to evaluate dietary micronutrient intake in non-pregnant and non-lactating Chinese women aged 18–49 years, and to analyze the relationship between dietary micronutrient intake and overweight and obesity. Data were obtained from 2015 China Adult Chronic Disease and Nutrition Surveillance (CACDNS 2015). In CACDNS 2015, 12,872 women aged 18 to 49 years (excluding pregnant women and lactating mothers) were surveyed for a three-day 24 h dietary recall and a three-day household weighing of edible oil and condiments. The average daily dietary intake of micronutrients was calculated according to the Chinese food composition table. In 2015, the median intake of vitamin A, vitamin B1, vitamin B2, vitamin C and folate in non-pregnant and non-lactating women aged 18–49 years in China was 267.0 μg RE/day, 0.7 mg/day, 0.6 mg/day, 63.5 mg/day and 121.0 μg/day, respectively. The median mean intake of vitamin A, niacin, calcium and zinc in overweight/obese group was lower than that in non-overweight/obese group, and the difference was statistically significant (p 2 intake (Q2 vs. Q1: OR = 1.256, 95% CI: 1.120~1.408; Q3 vs. Q1: OR = 1.416, 95% CI: 1.240~1.617; Q4 vs. Q1: OR = 1.515, 95% CI: 1.293–1.776), vitamin E intake (Q2 vs. Q1: OR = 1.114, 95% CI: 1.006–0.235; Q3 vs. Q1: OR = 1.162, 95% CI: 1.048~0.288; Q4 vs. Q1: OR = 1.234, 95% CI: 1.112–1.371) was a risk factor for overweight/obesity in females. The intakes of most dietary micronutrients in non-pregnant and non-lactating women aged 18–49 in China were low. The intakes of dietary vitamin A, niacin and zinc were negatively correlated with the risk of overweight/obesity, while the intakes of vitamin B2 and vitamin E were positively correlated with the risk of overweight/obesity

The Relationship between Birth Weight and the Risk of Overweight and Obesity among Chinese Children and Adolescents Aged 7–17 Years

Obesity is a major public health issue in children and adolescents. Our study aimed to examine the impacts of birth weight on overweight and obesity among Chinese children and adolescents. Using data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, we included 10,041 participants aged 7–17 years. According to birth weight, participants were categorized into six groups, and the birth weight category of 3000 to 3499 g was chosen as the reference group, containing the largest number of children. Logistic regression analyses were used to investigate the association of birth weight with the risk of being obese at 7 to 17 years of age in multivariable-adjusted models. A restricted cubic spline was utilized to show the odds ratios (ORs) of obesity at different birth weight levels. The adjusted ORs for overweight were 0.98 (95%CI 0.63, 1.53), 1.02 (95%CI 0.84, 1.25), 1.34 (95%CI 1.16, 1.55), 1.72 (95%CI 1.35, 2.18), and 1.17 (95%CI 0.71, 1.96) in several birth weight groups, compared with group C (3000–3499 g). The adjusted ORs for obesity were 0.82 (95%CI 0.48, 1.40), 0.77 (95%CI 0.60, 0.98), 1.33 (95%CI 1.13, 1.57), 1.97 (95%CI 1.53, 2.53), and 2.01 (95%CI 1.27, 3.19). Furthermore, children in the post-pubertal stage had a slightly higher risk of overweight and obesity than those in the pre-pubertal and pubertal stage. Moreover, these associations were stronger among boys. The lower part of normal birth weight range is associated with a lower risk of overweight and obesity in children and adolescents. However, higher levels of birth weight increase risk