Publications by authors named "Changzheng Yuan"

39 Publications

Causal Linkage Between Inflammatory Bowel Disease and Primary Sclerosing Cholangitis: A Two-Sample Mendelian Randomization Analysis.

Front Genet 2021 18;12:649376. Epub 2021 Mar 18.

Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, China.

Background: Observational studies suggest an association between inflammatory bowel disease (IBD) [including ulcerative colitis (UC) and Crohn's disease (CD)] and Primary sclerosing cholangitis (PSC), but the causal association between the two diseases remains unclear.

Methods: We used two-sample Mendelian randomization (MR) to estimate the causal association between IBD and PSC. We chose single nucleotide polymorphisms (SNPs) data for analysis, obtained from previous genome-wide association studies (GWASs). Pleiotropy, heterogeneity, and sensitivity analyses were performed for quality control.

Results: We found that the causal associations between IBD (both UC and CD) and PSC were significant (e.g., IBD and PSC, Robust adjusted profile score (RAPS) OR = 1.29, 95% CI 1.16∼1.44, < 0.01; UC and PSC, RAPS OR = 1.40, 95% CI 1.23∼1.58, < 0.01; CD and PSC, RAPS OR = 1.13, 95% CI 1.02∼1.26, = 0.02). MR Egger, IVW, and ML tests found statistical heterogeneity between determined IV estimates. The leave-one-out analysis also indicated the sensitivity of the SNPs (e.g., IBD and PSC, MR-Egger Q = 644.30, < 0.01; UC and PSC, MR-Egger Q = 378.30, < 0.01; UC and PSC, MR-Egger Q = 538.50, < 0.01).

Conclusion: MR analyses support the positive causal effect of IBD (including UC and CD) on PSC in a European population. We provide suggestions for preventing and treating the two diseases.
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http://dx.doi.org/10.3389/fgene.2021.649376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012893PMC
March 2021

Longitudinal association between home and community-based services provision and cognitive function in Chinese older adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey.

Health Soc Care Community 2021 Mar 24. Epub 2021 Mar 24.

School of Public Health and Management, Wenzhou Medical University, Wenzhou, China.

Few studies have assessed the impact of home and community-based services (HCBSs) provision on cognitive function among older adults over time. This study examined the longitudinal association between HCBSs provision and cognitive function in Chinese older adults. The study included 5,134 participants aged 65 years and older in the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive function over the same time period. Participants were asked what kind of HCBSs were provided in his or her community. However, they were not asked whether services were utilised. The study used the number of HCBSs provided each wave to represent the strength of HCBSs, and used the MMSE score of each wave to represent the older adults' cognitive function status. A latent growth model was used to explore the relationship between HCBSs provision and cognitive function of older adults. The number of HCBSs provided was positively associated with older adults' cognitive function (2008: β = 0.03, p = 0.031; 2011: β = 0.06, p < 0.001; 2014: β = 0.06, p < 0.001) after controlling for gender, age, residence, education, income, medical insurance, activities of daily living disability, instrumental activities of daily living disability, serious illness, living arrangement and marital status. Results provided longitudinal evidence that an increase in HCBSs provision at a national level can result in better cognitive function in Chinese older adults.
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http://dx.doi.org/10.1111/hsc.13353DOI Listing
March 2021

Quality of life of children with spinal muscular atrophy and their caregivers from the perspective of caregivers: a Chinese cross-sectional study.

Orphanet J Rare Dis 2021 01 6;16(1). Epub 2021 Jan 6.

Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.

Background: Spinal muscular atrophy (SMA) is an autosomal-recessive motor neuron disease leading to dysfunction of multiple organs. SMA can impair the quality of life (QoL) of patients and family. We aimed to evaluate the QoL of children with SMA and their caregivers and to identify the factors associated with QoL in a cross-sectional study conducted in China.

Methods: We recruited 101 children aged 0-17 years with SMA and their caregivers from a children's hospital in China. Twenty-six children had type I SMA, 56 type II and 19 type III. Each child's QoL was measured by the Pediatric Quality of Life Inventory 3.0 Neuromuscular Module (PedsQL NMM), which was completed by the child's caregivers. The caregiver's QoL was measured by the Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM). Information on sociodemographic characteristics, disease-specific characteristics, and treatments were collected using the proxy-reported questionnaire. Two-sample t tests and one-way ANOVA were used to compare differences in average scores of QoL across subgroups.

Results: Children with type III SMA had a higher average Total score of PedsQL NMM and higher average scores in domains Neuromuscular disease and Family resources than children with type I or type II SMA (p < 0.001). Caregivers of children with type III SMA reported higher average scores in the domains of Physical, Emotional, Social, and Cognitive functioning of the PedsQL FIM than those of children with types I or II SMA (p < 0.05). In addition, disease-related characteristics (e.g. limited mobility, stable course of disease, skeleton deformity, and digestive system dysfunction) and respiratory support were associated with lower average scores of PedsQL NMM and PedsQL FIM (p < 0.05). Exercise training, multidisciplinary team management and use of the medication Nusinersen were each associated with higher average scores in both PedsQL NMM and FIM (p < 0.05).

Conclusion: Our study has demonstrated factors that may impair or improve QoL of children patients with SMA and their parents. Particularly, QoL was relatively poor in children with type I and type II SMA as well as in their caregivers compared to those with type III SMA. We strongly recommend that standard of care in a multidisciplinary team be strengthened to improve the QoL of SMA patients. Our study called for increased attention from clinical physicians on measuring QoL in their clinical practices in order to enhance the understanding of impacts of SMA and to make better decisions regarding treatment.
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http://dx.doi.org/10.1186/s13023-020-01638-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789582PMC
January 2021

Reproducibility and Validity of a Semi-quantitative Food Frequency Questionnaire in Men Assessed by Multiple Methods.

Am J Epidemiol 2020 Dec 22. Epub 2020 Dec 22.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Among 626 participants of the Men's Lifestyle Validation Study (2011-2013), we evaluated the validity and reproducibility of a self-administered 152-item semiquantitative food frequency questionnaire (SFFQ) using two 7-day dietary records (7DDRs), four automated self-administered 24-hour dietary recalls (ASA24s), four 24-hour urine samples, one doubly-labeled water measurement (repeated in 104 participants), and two fasting blood samples, collected over 15 months. Compared to 7DDRs, SFFQs underestimated energy intake, macronutrients, and sodium intake, but overestimated some micronutrients. The mean of Spearman correlation coefficients was 0.66 (range 0.38 to 0.88) between 46 energy-adjusted nutrients estimated from 7DDRs and the final SFFQ, de-attenuated for within-person variation in the 7DDRs. These deattenuated correlations were similar using ASA24s as the comparison. Relative to biomarkers, SFFQs underestimated energy, sodium, and protein intakes, and the sodium:potassium ratio. The energy-adjusted correlations between the final SFFQ and the biomarkers were slightly lower than the correlations between the SFFQ and 7DDRs. Using method of triads to calculate validity coefficients (VC), the median VC between SFFQ and true intake was 0.65 and 0.69 using 7DDRs or ASA24s as the third method. These data indicate that this SFFQ provided reasonably valid estimates for a wide range of nutrients when evaluated by multiple comparison methods.
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http://dx.doi.org/10.1093/aje/kwaa280DOI Listing
December 2020

Higher environmental composite quality index score and risk of asthma and allergy in Northeast China.

Allergy 2020 Nov 28. Epub 2020 Nov 28.

Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China.

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http://dx.doi.org/10.1111/all.14672DOI Listing
November 2020

Dietary carotenoids related to risk of incident Alzheimer dementia (AD) and brain AD neuropathology: a community-based cohort of older adults.

Am J Clin Nutr 2020 Nov 12. Epub 2020 Nov 12.

Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, USA.

Background: Studies have reported a protective relation to cognitive decline with long-term intake of total and individual dietary carotenoids. However, the underlying mechanisms have not yet been clearly established in humans.

Objectives: To evaluate the prospective association between intakes of total and individual carotenoids and risk of incident Alzheimer dementia (AD) and explore the underlying neuropathological basis.

Methods: Among 927 participants from the Rush Memory and Aging Project who were free from AD at baseline and were followed up for a mean of 7 y, we estimated HRs for AD using Cox proportional hazards models by intakes of energy-adjusted carotenoids. Brain AD neuropathology was assessed in postmortem brain autopsies among 508 deceased participants. We used linear regression to assess the association of carotenoid intake with AD-related neuropathology.

Results: Higher intake of total carotenoids was associated with substantially lower hazard of AD after controlling for age, sex, education, ApoE-ε4, participation in cognitively stimulating activities, and physical activity level. Comparing the top and bottom quintiles (median intake: 24.8 compared with 6.7 mg/d) of total carotenoids, the multivariate HR (95% CI) was 0.52 (0.33, 0.81), P-trend < 0.01. A similar association was observed for lutein-zeaxanthin, a weaker linear inverse association was observed for β-carotene, and a marginally significant linear inverse association was found for β-cryptoxanthin. Among the deceased participants, consumers of higher total carotenoids (top compared with bottom tertile, 18.2 compared with 8.2 mg/d) had less global AD pathology (b: -0.10; SE = 0.04; P-trend = 0.01). For individual carotenoids, lutein-zeaxanthin and lycopene were inversely associated with brain global pathology, whereas lutein-zeaxanthin showed additional inverse associations with AD diagnostic score, neuritic plaque severity, and neurofibrillary tangle density and severity.

Conclusions: Our findings support a beneficial role of total carotenoid consumption, in particular lutein/zeaxanthin, on AD incidence that may be related to the inhibition of brain β-amyloid deposition and fibril formation.
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http://dx.doi.org/10.1093/ajcn/nqaa303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779228PMC
November 2020

Effect of a Text Messaging-Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial.

JMIR Mhealth Uhealth 2020 11 3;8(11):e19953. Epub 2020 Nov 3.

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.

Background: Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China's cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China's 2016 two-child policy has heightened the implications of national cesarean section trends.

Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates.

Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi'an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother's birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few "basic" messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman's gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment.

Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy.

Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women's likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates.

Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087.

International Registered Report Identifier (irrid): RR2-10.1136/bmjopen-2015-011016.
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http://dx.doi.org/10.2196/19953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671841PMC
November 2020

Changes in dietary patterns among youths in China during COVID-19 epidemic: The COVID-19 impact on lifestyle change survey (COINLICS).

Appetite 2021 03 27;158:105015. Epub 2020 Oct 27.

International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. Electronic address:

Limited studies have focused on how COVID-19 outbreak and thereby lockdown have affected the youth's diet patterns. This study aimed to assess changes in diet patterns among youths in China under the COVID-19 lockdown, based on the COVID-19 Impact on Lifestyle Change Survey (COINLICS), a nationwide retrospective survey distributed via social media platforms during 9-12 May 2020 where 10,082 youth participants in China have voluntarily reported their basic sociodemographic information and routine diet patterns in the months before and after COVID-19 lockdown. We used paired t-tests or χ tests to evaluate the significance of differences in consumption patterns of 12 major food groups and beverages across educational levels, between sexes, and before and after COVID-19 lockdown. During the COVID-19 lockdown, significant decreases were observed in the frequency of intake of rice, meat, poultry, fresh vegetables, fresh fruit, soybean products, and dairy products, with significant sex differences (females consuming more rice, fresh vegetables and fruit and less meat, poultry, soybean and dairy products than males). Significant increases were observed in the frequency of consumption of wheat products, other staple foods, and preserved vegetables, with males consuming these foods more frequently than females. Graduate students consumed most foods more frequently except rice and other staple foods and preserved vegetables. The frequency of sugar-sweetened beverage consumption had decreased while frequency of tea drinking had increased. The participating youths' diet patterns had significantly changed during the COVID-19 lockdown, with heterogeneities observed to different extents between sexes and across educational levels. Our findings would inform policy-makers and health professionals of these changes in time for better policy making and public health practice.
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http://dx.doi.org/10.1016/j.appet.2020.105015DOI Listing
March 2021

Grand-maternal lifestyle during pregnancy and body mass index in adolescence and young adulthood: an intergenerational cohort study.

Sci Rep 2020 09 2;10(1):14432. Epub 2020 Sep 2.

Department of Nutrition, Harvard School of Public Health, Harvard University, 655 Huntington Ave, Boston, MA, 02115, USA.

To examine associations of healthy lifestyle during pregnancy with body mass index (BMI) and risk of overweight or obesity of grandchildren during adolescence and young adulthood. Our study population included 14,001 grandmother-mother-child triads comprised of participants of two ongoing prospective cohort studies of related individuals. We used self-reported grand-maternal gestational weight gain, diet, physical activity, and smoking during pregnancy to create a lifestyle score ranged from 0 to 12, with a higher score indicating healthier lifestyle. Grandchild BMI was self-assessed in follow-up questionnaires. Compared with individuals whose grandmothers had the least healthy lifestyle during pregnancy, individuals whose grandmothers had the most healthy lifestyle had 0.17 (95% CI 0.01, 0.33; P for trend = 0.05) kg/m lower BMI and 7% (95% CI 2%, 12%; P for trend = 0.001) lower risk of overweight or obesity during adolescence and young adulthood. The inverse associations between grand-maternal lifestyle and BMI in grandchildren were mainly mediated by maternal pre-pregnancy BMI (mediation effect: 64%; P value = 0.001). Overall, maternal BMI, along with maternal socioeconomic status and lifestyle factors in the second and third generations accounted for all of the inter-generational association (mediation effect: 99%; P value < 0.001). The inverse associations of grand-maternal lifestyle with BMI of offspring were not modified by grand-maternal pre-pregnancy BMI, grandchild age, or grandchild gender. Grandchildren of women who had the healthiest lifestyles during pregnancy defined by no excess gestational weight gain, no smoking, a healthy diet and being physically active, were less likely to be overweight or obese in adolescence and early adulthood.
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http://dx.doi.org/10.1038/s41598-020-71461-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468235PMC
September 2020

Information Disclosure During the COVID-19 Epidemic in China: City-Level Observational Study.

J Med Internet Res 2020 08 27;22(8):e19572. Epub 2020 Aug 27.

Institute of Medical Information/Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Information disclosure is a top priority for official responses to the COVID-19 pandemic. The timely and standardized information published by authorities as a response to the crisis can better inform the public and enable better preparations for the pandemic; however, there is limited evidence of any systematic analyses of the disclosed epidemic information. This in turn has important implications for risk communication.

Objective: This study aimed to describe and compare the officially released content regarding local epidemic situations as well as analyze the characteristics of information disclosure through local communication in major cities in China.

Methods: The 31 capital cities in mainland China were included in this city-level observational study. Data were retrieved from local municipalities and health commission websites as of March 18, 2020. A checklist was employed as a rapid qualitative assessment tool to analyze the information disclosure performance of each city. Descriptive analyses and data visualizations were produced to present and compare the comparative performances of the cities.

Results: In total, 29 of 31 cities (93.5%) established specific COVID-19 webpages to disclose information. Among them, 12 of the city webpages were added to their corresponding municipal websites. A majority of the cities (21/31, 67.7%) published their first cases of infection in a timely manner on the actual day of confirmation. Regarding the information disclosures highlighted on the websites, news updates from local media or press briefings were the most prevalent (28/29, 96.6%), followed by epidemic surveillance (25/29, 86.2%), and advice for the public (25/29, 86.2%). Clarifications of misinformation and frequently asked questions were largely overlooked as only 2 cities provided this valuable information. The median daily update frequency of epidemic surveillance summaries was 1.2 times per day (IQR 1.0-1.3 times), and the majority of these summaries (18/25, 72.0%) also provided detailed information regarding confirmed cases. The reporting of key indicators in the epidemic surveillance summaries, as well as critical facts included in the confirmed case reports, varied substantially between cities. In general, the best performance in terms of timely reporting and the transparency of information disclosures were observed in the municipalities directly administered by the central government compared to the other cities.

Conclusions: Timely and effective efforts to disclose information related to the COVID-19 epidemic have been made in major cities in China. Continued improvements to local authority reporting will contribute to more effective public communication and efficient public health research responses. The development of protocols and the standardization of epidemic message templates-as well as the use of uniform operating procedures to provide regular information updates-should be prioritized to ensure a coordinated national response.
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http://dx.doi.org/10.2196/19572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473703PMC
August 2020

Vitamin B12, B6, or Folate and Cognitive Function in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

J Alzheimers Dis 2020 ;77(2):781-794

Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.

Background: Previous studies have indicated that B vitamin deficiencies are an essential cause of neurological pathology. There is a need to provide evidence of the benefit of B vitamins for the prevention of cognitive decline in community-dwelling older adults.

Objective: To examine the association between intake and plasma levels of vitamins B12, B6, and folate and cognitive function in older populations through a systematic review and meta-analysis.

Methods: Medline (PubMed), EMBASE, and Cochrane databases were used to search the literature though August 8, 2019. We included observational population-based studies evaluating the association between concentrations or intake levels of vitamins B6, B12, or folate and cognition in older adults aged ≥45 years. The quality of all studies was assessed by the modified Newcastle-Ottawa Scale. Odds ratios (ORs) and hazard ratios (HRs) were analyzed by the random-effects model. Sensitivity analyses were conducted by excluding the studies with significant heterogeneity.

Results: Twenty-one observational studies with sample sizes ranging from 155-7030 were included in the meta-analysis. Higher levels of vitamin B12 (OR = 0.77, 95% CI = 0.61-0.97) and folate concentration (OR = 0.68, 95% CI = 0.51-0.90) were associated with better cognition in cross-sectional studies, but not in sensitivity analyses or prospective studies. High vitamin B6 concentrations showed no significant benefit on cognition and dementia risk. Prospective studies did not provide substantial evidence for the relationship.

Conclusion: The results from our meta-analysis suggest that vitamins B12, B6, and folate may not be modifiable risk factors for slowing cognitive decline among community-dwelling older individuals.
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http://dx.doi.org/10.3233/JAD-200534DOI Listing
January 2020

Dietary flavonoids and flavonoid-rich foods: validity and reproducibility of FFQ-derived intake estimates.

Public Health Nutr 2020 12 23;23(18):3295-3303. Epub 2020 Jul 23.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Objective: To evaluate the validity and reproducibility of a 152-item semi-quantitative FFQ (SFFQ) for estimating flavonoid intakes.

Design: Over a 1-year period, participants completed two SFFQ and two weighed 7-d dietary records (7DDR). Flavonoid intakes from the SFFQ were estimated separately using Harvard (SFFQHarvard) and Phenol-Explorer (SFFQPE) food composition databases. 7DDR flavonoid intakes were derived using the Phenol-Explorer database (7DDRPE). Validity was assessed using Spearman's rank correlation coefficients deattenuated for random measurement error (rs), and reproducibility was assessed using rank intraclass correlation coefficients.

Setting: This validation study included primarily participants from two large observational cohort studies.

Participants: Six hundred forty-one men and 724 women.

Results: When compared with two 7DDRPE, the validity of total flavonoid intake assessed by SFFQPE was high for both men and women (rs = 0·77 and rs = 0·74, respectively). The rs for flavonoid subclasses ranged from 0·47 for flavones to 0·78 for anthocyanins in men and from 0·46 for flavonols to 0·77 for anthocyanins in women. We observed similarly moderate (0·4-0·7) to high (≥0·7) validity when using SFFQHarvard estimates, except for flavonesHarvard (rs = 0·25 for men and rs = 0·19 for women). The SFFQ demonstrated high reproducibility for total flavonoid and flavonoid subclass intake estimates when using either food composition database. The intraclass correlation coefficients ranged from 0·69 (flavonolsPE) to 0·80 (proanthocyanidinsPE) in men and from 0·67 (flavonolsPE) to 0·77 (flavan-3-ol monomersHarvard) in women.

Conclusions: SFFQ-derived intakes of total flavonoids and flavonoid subclasses (except for flavones) are valid and reproducible for both men and women.
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http://dx.doi.org/10.1017/S1368980020001627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736217PMC
December 2020

Association between access to full-service restaurants and childhood obesity.

Obes Rev 2021 02 3;22 Suppl 1:e13076. Epub 2020 Jul 3.

Department of Health Service Management, School of Public Health, Tianjin Medical University, Tianjin, China.

The lack of access to full-service restaurants (FSRs) is generally thought to be a risk factor for childhood obesity, as it could discourage healthful eating-out behaviours while increasing the exposure to unhealthful food venues as "compensatory" options. However, the association between FSR access and childhood obesity has not been comprehensively reviewed previously. A literature search was conducted on PubMed and Web of Science for articles published before 1 January 2019 that examined the association between FSR access and weight-related behaviours and outcomes among children and adolescents. Eighteen studies conducted in three countries were identified, published from 2006 to 2018 with a median sample size of 2352 (ranging from 323 to 529 367). Findings were mixed among these 18 studies that reported on the association between access to FSRs and weight-related outcomes. Our meta-analyses showed that there were no significant associations of FSR access with the level of body mass index (BMI) and the BMI z-score among children. Also, there was no apparent evidence on the association between FSR access and the risk of overweight/obesity. Our results need to be interpreted with caution, considering the menu quality of FSRs and heterogeneity of eligible studies in this meta-analysis. Well-designed epidemiologic studies are warranted to further elaborate on the potential association between FSR access and children's weight status.
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http://dx.doi.org/10.1111/obr.13076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988535PMC
February 2021

Long-Term Intake of Dietary Carotenoids Is Positively Associated with Late-Life Subjective Cognitive Function in a Prospective Study in US Women.

J Nutr 2020 07;150(7):1871-1879

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Background: A protective association of dietary carotenoids with cognitive function has been suggested, but most studies have been relatively small with limited periods of follow-up.

Objectives: We examined prospectively long-term intakes of carotenoids in relation to subjective cognitive function (SCF), a self-reported, validated indicator of cognitive dysfunction.

Methods: Among 49,493 female registered nurses with a mean age of 48 y in 1984, we used multinomial logistic regression to estimate the ORs and 95% CIs relating intakes of carotenoids to self-reported SCF in 2012 and 2014. Mean intakes of carotenoids were calculated from 7 repeated FFQs collected in 1984, 1986, and every 4 y afterwards until 2006. Self-reported SCF was assessed by a 7-item questionnaire on changes in memory and cognition; validity was supported by strong associations with Apolipoprotein E (APOE) ε4 genotype and concurrent cognitive function and cognitive decline measured by telephone-based neuropsychological tests. The mean values of scores assessed in 2012 and 2014 were categorized as "good" (0 points, 40.8%), "moderate" (0.5-2.5 points, 46.9%), and "poor" (3-7 points, 12.3%).

Results: Higher intake of total carotenoids was associated with substantially lower odds of moderate or poor cognitive function after controlling for other dietary and nondietary risk factors and total energy intake. Comparing the top with the bottom quintile of total carotenoids, the multivariable ORs were 0.86 (95% CI: 0.80, 0.93; P-trend < 0.001) for moderate SCF and 0.67 (95% CI: 0.60, 0.75; P-trend < 0.001) for poor SCF. This lower OR was also seen for carotenoids consumed 28 y before SCF assessment. Similar associations were found for total β-carotene, dietary β-carotene, α-carotene, lycopene, lutein + zeaxanthin, and β-cryptoxanthin. The significant associations for β-cryptoxanthin, lycopene, and lutein + zeaxanthin persisted after mutual adjustment for each other.

Conclusions: Our findings support a long-term beneficial role of carotenoid consumption on cognitive function in women.
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http://dx.doi.org/10.1093/jn/nxaa087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330480PMC
July 2020

Trajectories of cognitive function and their determinants in older people: 12 years of follow-up in the Chinese Longitudinal Healthy Longevity Survey.

Int Psychogeriatr 2020 06 27;32(6):765-775. Epub 2020 Apr 27.

Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.

Background: Cognitive decline in advanced age is closely related to dementia. The trajectory of cognitive function in older Chinese is yet to be fully investigated. We aimed to investigate the trajectories of cognitive function in a nationally representative sample of older people living in China and to explore the potential determinants of these trajectories.

Methods: This study included 2,038 cognitively healthy persons aged 65-104 years at their first observation in the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014. Cognitive function was measured using the Chinese version of the Mini-Mental State Examination (MMSE). Group-based trajectory modeling was used to identify potential heterogeneity of longitudinal changes over the 12 years and to investigate associations between baseline predictors of group membership and these trajectories.

Results: Three trajectories were identified according to the following types of changes in MMSE scores: slow decline (14.0%), rapid decline (4.5%), and stable function (81.5%). Older age, female gender, having no schooling, a low frequency of leisure activity, and a low baseline MMSE score were associated with the slow decline trajectory. Older age, body mass index (BMI) less than 18.5 kg/m2, and having more than one cardiovascular disease (CVD) were associated with the rapid decline trajectory.

Conclusion: Three trajectories of cognitive function were identified in the older Chinese population. The identified determinants of these trajectories could be targeted for developing prevention and intervention strategies for dementia.
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http://dx.doi.org/10.1017/S1041610220000538DOI Listing
June 2020

Association of Birth by Cesarean Delivery With Obesity and Type 2 Diabetes Among Adult Women.

JAMA Netw Open 2020 04 1;3(4):e202605. Epub 2020 Apr 1.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Importance: Cesarean delivery is associated with an increased risk of childhood obesity in offspring. However, whether this increased risk also includes obesity-associated conditions remains unclear.

Objective: To evaluate the association of birth by cesarean delivery with offspring's risks of obesity and type 2 diabetes in adulthood.

Design, Setting, And Participants: This prospective cohort study compared the incidence of obesity and type 2 diabetes between birth by cesarean delivery and vaginal delivery among 33 226 women participating in the Nurses' Health Study II who were born between 1946 and 1964, with follow-up through the end of the 2013-2015 follow-up cycle. Participants' mothers provided information on mode of delivery and pregnancy characteristics. Participants provided information every 2 years on weight and diagnosis of type 2 diabetes. Relative risks of obesity and type 2 diabetes were estimated using log-binomial and proportional hazards regression accounting for maternal body mass index and other confounding factors. Statistical analysis was performed from June 2017 to December 2019.

Exposure: Birth by cesarean delivery compared with birth by vaginal delivery.

Main Outcomes And Measures: Risk of obesity and incidence of type 2 diabetes.

Results: At baseline, the participants' mean (SD) age was 33.8 (4.6) years (range, 24.0-44.0 years). A total of 1089 of the 33 226 participants (3.3%) were born by cesarean delivery. After 1 913 978 person-years of follow-up, 12 156 (36.6%) women were obese and 2014 (6.1%) had received a diagnosis of type 2 diabetes. Women born by cesarean delivery were more likely to be classified as obese and to have received a diagnosis of type 2 diabetes during follow-up. The multivariable-adjusted relative risk of obesity among women born by cesarean vs vaginal delivery was 1.11 (95% CI, 1.03-1.19). The multivariable-adjusted hazard ratio for type 2 diabetes among women born by cesarean vs vaginal delivery was 1.46 (95% CI, 1.18-1.81); this association remained significant after additional adjustment for participant's own body mass index (relative risk, 1.34 [95% CI, 1.08-1.67]). These associations persisted when analyses were restricted to women at low risk of cesarean delivery based on maternal characteristics.

Conclusions And Relevance: This study suggests that women born by cesarean delivery may have a higher risk than women born by vaginal delivery of being obese and developing type 2 diabetes during adult life.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.2605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154804PMC
April 2020

The Effects on Inappropriate Weight for Gestational Age of an SMS Based Educational Intervention for Pregnant Women in Xi'an China: A Quasi-Randomized Controlled Trial.

Int J Environ Res Public Health 2020 02 25;17(5). Epub 2020 Feb 25.

The Children's Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China.

Background: The aim of this study was to estimate the effects of maternal text messages on inappropriate weight for gestational age (IWGA) in newborns in rural China.

Methods: Participants were pregnant women presenting for antenatal care at a Maternal and Child Health Center in Xi'an, China during the 2013-2015 period. In total, 2115 women completed the program with follow-up information included in the final analyses. All mothers were divided into four groups, including (1) a control group that received only a few "Basic" messages, (2) a Care-Seeking (CS) message group, (3) Good Household Prenatal Practices (GHPP) message group, and (4) a group receiving all 148 text messages. The primary outcome was IWGA, including small for gestational age (SGA) and macrosomia (weighing ≥4000g at birth). Multivariable logistic regression using an intent-to-treat estimate was utilized.

Results: In total, 19.5% of newborns were IWGA. The risk of IWGA was 23.0% in the control group, 19.6% in the CS group, 18.9% in the GHPP group, and 16.5% in the group with All Texts. Compared to the control group, the odds ratio of IWGA was 0.65 (0.48-0.89) for the group receiving All Texts, which remained statistically significant after performing the Holm-Bonferroni correction. The odds ratio of macrosomia was 0.54 (0.34-0.87) and 0.57 (0.36-0.49) for the Care Seeking message group and the All Texts group, respectively, with statistical significance.

Conclusion: A package of free informational text messages, including advice for good household prenatal practices and care seeking, may prevent the inappropriate weight for gestational age through a protective effect on macrosomia. Advice to encourage care seeking in pregnancy may prevent macrosomia among neonates in rural China as well.
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http://dx.doi.org/10.3390/ijerph17051482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084866PMC
February 2020

Reliability of Repeated Measures of Nutrient Intake by Diet Records in Residents in the Western Region of Japan.

Nutrients 2019 Oct 18;11(10). Epub 2019 Oct 18.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

Objective: We aimed to assess the day-to-day variation in twelve one-day diet records over one year from 131 residents of urban and rural areas in the western region of Japan.

Methods: Between 2014 and 2015, the participants provided repeated one-day diet records once a month. We estimated the intraclass correlation coefficient (ICCs) for intakes for energy and 39 crude and energy-adjusted nutrients using linear mixed models.

Results: Among the unadjusted nutrients, ICCs ranged from 0.05 (95 percent confidence interval = 0.03-0.09) for vitamin A retinol equivalent (RE) to 0.55 (95% CI = 0.48-0.62) for potassium. After energy adjustment, the ICCs were 0.02 (95 percent confidence interval = 0.03-0.09) for vitamin A (RE) and 0.52 (95 percent confidence interval = 0.45-0.59) for potassium. Intakes of energy-adjusted macronutrients tended to have moderate degrees of day-to-day coefficients of variation (CV range = 0.13-0.23, mean = 0.18), while the coefficients of variation for intakes of micronutrients varied dramatically (CV range = 0.17-2.59, mean = 0.54).

Conclusion: There were large day-to-day variations in nutrient intake assessed by diet records among urban and rural residents in the western region of Japan. This study provided information on the reproducibility of crude and energy-adjusted nutrients that may be useful for other dietary studies in Japanese populations.
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http://dx.doi.org/10.3390/nu11102515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835429PMC
October 2019

Long-term intake of vegetables and fruits and subjective cognitive function in US men.

Neurology 2019 01 21;92(1):e63-e75. Epub 2018 Nov 21.

From the Departments of Nutrition (C.Y., E.F., A.A., W.C.W.) and Epidemiology (A.A., O.I.O., F.G., W.C.W.), Harvard T.H. Chan School of Public Health, Boston; Channing Division of Network Medicine (C.Y., E.F., A.A., O.I.O., F.G., W.C.W.) and Department of Psychiatry (O.I.O.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Harvard Medical School (A.B.), Boston, MA.

Objective: To evaluate the prospective association of long-term intake of vegetables and fruits with late-life subjective cognitive function (SCF).

Methods: Among 27,842 men with a mean age of 51 years in 1986, we used multinomial logistic regression to examine the relation of vegetable and fruit consumption to future SCF. Average dietary intake was calculated from 5 repeated food frequency questionnaires collected every 4 years until 2002. SCF score was assessed twice (2008 and 2012) using a 6-item questionnaire; validity was supported by strong associations with ε4 genotype. We categorized the average of the 2 scores as good, moderate, and poor SCF.

Results: Higher intakes of total vegetables, total fruits, and fruit juice were each significantly associated with lower odds of moderate or poor SCF after controlling for major nondietary factors and total energy intake. The association with total fruit intake was weaker after further adjusting for major dietary factors. In this model, the multivariate odds ratios (95% confidence intervals) for vegetable intake (top vs bottom quintile) were 0.83 (0.76-0.92), trend <0.001 for moderate SCF and 0.66 (0.55-0.80), trend <0.001 for poor SCF. For orange juice, compared to <1 serving/mo of intake, daily consumption was associated with a substantially lower odds of poor SCF (0.53 [0.43-0.67], trend <0.001). Higher consumption of vegetables and fruits 18 to 22 years before SCF assessment was associated with lower odds of poor SCF independent of more proximal intake.

Conclusion: Our findings support a long-term beneficial role of vegetable, fruit, and orange juice consumption on SCF.
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http://dx.doi.org/10.1212/WNL.0000000000006684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336164PMC
January 2019

Lifestyle of women before pregnancy and the risk of offspring obesity during childhood through early adulthood.

Int J Obes (Lond) 2018 07 3;42(7):1275-1284. Epub 2018 Mar 3.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Background: In women, adhering to an overall healthy lifestyle is associated with a dramatically reduced risk of cardio-metabolic disorders. Whether such a healthy lifestyle exerts an intergenerational effects on child health deserves examination.

Methods: We included 5701 children (9-14 years old at baseline) of the Growing Up Today Study 2, and their mothers, who are participants in the Nurses' Health Study II. Pre-pregnancy healthy lifestyle was defined as a normal body mass index, no smoking, physical activity ≥150 min/week, and diet in the top 40% of the Alternative Healthy Eating Index-2010. Obesity during childhood and adolescence was defined using the International Obesity Task Force age- and sex-specific cutoffs. Multivariable log-binominal regression models with generalized estimating equations were used to evaluate the association of pre-pregnancy healthy lifestyle and offspring obesity.

Results: We identified 520 (9.1%) offspring who became obese during follow-up. A healthy body weight of mothers and no smoking before pregnancy was significantly associated with a lower risk of obesity among offspring: the relative risks [RRs; 95% confidence intervals (CIs)] were 0.37 (0.31-0.43) and 0.64 (0.49-0.84), respectively. Eating a healthy diet and regular moderate-to-vigorous physical activities were inversely related to offspring obesity risk, but these relations were not statistically significant. Compared to children of mothers who did not meet any low-risk lifestyle factors, offspring of women who adhered to all four healthy lifestyle factors had 75% lower risk of obesity (RR: 0.25, 95% CI: 0.14-0.43).

Conclusion: Adherence to an overall healthy lifestyle before pregnancy is strongly associated with a low risk of offspring obesity in childhood, adolescence, and early adulthood. These findings highlight the importance of an overall healthy lifestyle before pregnancy as a potential strategy to prevent obesity in future generations.
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http://dx.doi.org/10.1038/s41366-018-0052-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727198PMC
July 2018

Adherence to Mediterranean diet and subjective cognitive function in men.

Eur J Epidemiol 2018 02 17;33(2):223-234. Epub 2017 Nov 17.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.

Benefits of a Mediterranean diet for cognition have been suggested, but epidemiologic studies have been relatively small and of limited duration. To prospectively assess the association between long-term adherence to a Mediterranean dietary pattern and self-reported subjective cognitive function (SCF). Prospective observational study. The Health Professionals' Follow-up Study, a prospective cohort of 51,529 men, 40-75 years of age when enrolled in 1986, of whom 27,842 were included in the primary analysis. Mediterranean diet (MD) score, computed from the mean of five food frequency questionnaires, assessed every 4 years from 1986 to 2002. Self-reported SCF assessed by a 6-item questionnaire in 2008 and 2012, and validated by association with genetic variants in apolipoprotein-4. Using the average of 2008 and 2012 SCF scores, 38.0% of men were considered to have moderate memory scores and 7.3% were considered to have poor scores. In a multivariate model, compared with men having a MD score in the lowest quintile, those in the highest quintile had a 36% lower odds of a poor SCF score (odds ratio 0.64, 95% CI 0.55-0.75; P, trend < 0.001) and a 24% lower odds of a moderate SCF score (OR 0.76, 95% CI 0.70-0.83; P, trend < 0.001). Both remote and more recent diet contributed to this relation. Associations were only slightly weaker using baseline dietary data and a lag of 22 years. Long-term adherence to the Mediterranean diet pattern was strongly related to lower subjective cognitive function. These findings provide further evidence that a healthy dietary pattern may prevent or delay cognitive decline.
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http://dx.doi.org/10.1007/s10654-017-0330-3DOI Listing
February 2018

Relative Validity of Nutrient Intakes Assessed by Questionnaire, 24-Hour Recalls, and Diet Records as Compared With Urinary Recovery and Plasma Concentration Biomarkers: Findings for Women.

Am J Epidemiol 2018 05;187(5):1051-1063

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

We evaluated the performance of a semiquantitative food frequency questionnaire (SFFQ), the Automated Self-Administered 24-Hour Dietary Recall (ASA24), and 7-day dietary records (7DDRs), in comparison with biomarkers, in the estimation of nutrient intakes among 627 women in the Women's Lifestyle Validation Study (United States, 2010-2012). Two paper SFFQs, 1 Web-based SFFQ, 4 ASA24s (beta version), 2 7DDRs, 4 24-hour urine samples, 1 doubly labeled water measurement (repeated among 76 participants), and 2 fasting blood samples were collected over a 15-month period. The dietary variables evaluated were energy, energy-adjusted intakes of protein, sodium, potassium, and specific fatty acids, carotenoids, α-tocopherol, retinol, and folate. In general, relative to biomarkers, averaged ASA24s had lower validity than the SFFQ completed at the end of the data-collection year (SFFQ2); SFFQ2 had slightly lower validity than 1 7DDR; the averaged SFFQs had validity similar to that of 1 7DDR; and the averaged 7DDRs had the highest validity. The deattenuated correlation of energy-adjusted protein intake assessed by SFFQ2 with its biomarker was 0.46, similar to its correlation with 7DDRs (deattenuated r = 0.54). These data indicate that the SFFQ2 provides reasonably valid measurements of energy-adjusted intake for most of the nutrients assessed in our study, consistent with earlier conclusions derived using 7DDRs as the comparison method. The ASA24 needs further evaluation for use in large population studies, but an average of 3 days of measurement will not be sufficient for some important nutrients.
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http://dx.doi.org/10.1093/aje/kwx328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928456PMC
May 2018

Offspring risk of obesity in childhood, adolescence and adulthood in relation to gestational diabetes mellitus: a sex-specific association.

Int J Epidemiol 2017 10;46(5):1533-1541

Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.

Background: Animal data suggest sexually dimorphic programming of obesity in response to altered intrauterine environment, but the longitudinal impact of gestational diabetes mellitus (GDM) on sex-specific risk of offspring obesity in humans is unclear.

Methods: We conducted a prospective analysis of 15 009 US individuals (7946 female and 7063 male) from the Growing-Up Today Study, who were followed from 1996 (ages 9-14 years) through 2010. Height and weight from validated questionnaires were used to derive body mass index (BMI) at different ages. Obesity during childhood (< 18 years) and adulthood (≥ 18 years) were defined using the International Obesity Task Force and the World Health Organization criteria. GDM exposure was identified through self-reported questionnaires from mothers. Relative risks were estimated using multivariable log-binomial regression models with generalized estimating equations accounting for clustering within the same family.

Results: Male offspring born from pregnancies complicated by GDM had higher BMI compared with non-GDM offspring and had increased risk of obesity; the adjusted relative risk [RR, 95% confidence interval (CI)] was 1.47 (1.11-1.95) for all age groups, 1.59 (1.05-2.41) for late childhood, 1.48 (1.06-2.06) for adolescence and 1.39 (1.00-1.94) for early adulthood. No significant association between obesity and maternal GDM was observed among female participants (RR = 0.97, 95% CI: 0.71-1.33).

Conclusions: The association of GDM with offspring obesity from late childhood through early adulthood may differ by sex; a significant association was observed among male but not female offspring.
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http://dx.doi.org/10.1093/ije/dyx151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837775PMC
October 2017

No association between dietary sodium intake and the risk of multiple sclerosis.

Neurology 2017 Sep 25;89(13):1322-1329. Epub 2017 Aug 25.

From the Departments of Clinical Medicine and Global Public Health and Primary Care (M.C.), University of Bergen; The Norwegian Multiple Sclerosis Competence Center (M.C.), Haukeland University Hospital, Bergen, Norway; Departments of Nutrition (M.C., C.Y., A.A., K.L.M.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

Objective: To prospectively investigate the association between dietary sodium intake and multiple sclerosis (MS) risk.

Methods: In this cohort study, we assessed dietary sodium intake by a validated food frequency questionnaire administered every 4 years to 80,920 nurses in the Nurses' Health Study (NHS) (1984-2002) and to 94,511 in the Nurses' Health Study II (NHSII) (1991-2007), and calibrated it using data from a validation study. There were 479 new MS cases during follow-up. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the effect of energy-adjusted dietary sodium on MS risk, adjusting also for age, latitude of residence at age 15, ancestry, body mass index at age 18, supplemental vitamin D intake, cigarette smoking, and total energy intake in each cohort. The results in both cohorts were pooled using fixed effects models.

Results: Total dietary intake of sodium at baseline was not associated with MS risk (highest [medians: 3.2 g/d NHS; 3.5 g/d NHSII] vs lowest [medians: 2.5 g/d NHS; 2.8 g/d NHSII] quintile: HR 0.98, 95% CI 0.74-1.30, for trend = 0.75). Cumulative average sodium intake during follow-up was also not associated with MS risk (highest [medians: 3.3 g/d NHS; 3.4 g/d NHSII] vs lowest [medians: 2.7 g/d NHS; 2.8 g/d NHSII] quintile: HR 1.02, 95% CI 0.76-1.37, for trend = 0.76). Comparing more extreme sodium intake in deciles yielded similar results ( for trend = 0.95).

Conclusions: Our findings suggest that higher dietary sodium intake does not increase the risk of developing MS.
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http://dx.doi.org/10.1212/WNL.0000000000004417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649760PMC
September 2017

Cycle Tracks and Parking Environments in China: Learning from College Students at Peking University.

Int J Environ Res Public Health 2017 08 18;14(8). Epub 2017 Aug 18.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

China has a historic system of wide cycle tracks, many of which are now encroached by cars, buses and bus stops. Even with these conditions, college students still bicycle. On campuses, students park their bikes on facilities ranging from kick-stand-plazas to caged sheds with racks, pumps and an attendant. In other countries, including Canada, some of the newer cycle tracks need to be wider to accommodate an increasing number of bicyclists. Other countries will also need to improve their bike parking, which includes garage-basement cages and two-tiered racks. China could provide lessons about cycle tracks and bike parking. This study applied the Maslow Transportation Level of Service (LOS) theory, i.e., for cycle tracks and bike parking, only after the basic needs of safety and security are met for both vehicle occupants and bicyclists can the higher needs of convenience and comfort be met. With random clustering, a self-administered questionnaire was collected from 410 students in six dormitory buildings at Peking University in Beijing and an environmental scan of bicycle parking conducted in school/office and living areas. Cycle tracks (1 = very safe/5 = very unsafe) shared with moving cars were most unsafe (mean = 4.6), followed by sharing with parked cars (4.1) or bus stop users (4.1) ( < 0.001). Close to half thought campus bike parking lacked order. The most suggested parking facilities were sheds, security (guard or camera), bicycle racks and bicycle parking services (pumps, etc.). If parking were improved, three quarters indicated they would bicycle more. While caged sheds were preferred, in living areas with 1597 parked bikes, caged sheds were only 74.4% occupied. For the future of China's wide cycle tracks, perhaps a fence-separated bus lane beside a cycle track might be considered or, with China's recent increase in bike riding, shared bikes and E-bikes, perhaps cars/buses could be banned from the wide cycle tracks. In other countries, a widened cycle track entrance should deter cars. Everywhere, bike parking sheds could be built and redesigned with painted lines to offer more space and order, similar to car parking.
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http://dx.doi.org/10.3390/ijerph14080930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580632PMC
August 2017

Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life.

JAMA 2017 Jul;318(3):255-269

Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Importance: Data describing the effects of weight gain across adulthood on overall health are important for weight control.

Objective: To examine the association of weight gain from early to middle adulthood with health outcomes later in life.

Design, Setting, And Participants: Cohort analysis of US women from the Nurses' Health Study (1976-June 30, 2012) and US men from the Health Professionals Follow-Up Study (1986-January 31, 2012) who recalled weight during early adulthood (at age of 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years).

Exposures: Weight change from early to middle adulthood (age of 18 or 21 years to age of 55 years).

Main Outcomes And Measures: Beginning at the age of 55 years, participants were followed up to the incident disease outcomes. Cardiovascular disease, cancer, and death were confirmed by medical records or the National Death Index. A composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment.

Results: A total of 92 837 women (97% white; mean [SD] weight gain: 12.6 kg [12.3 kg] over 37 years) and 25 303 men (97% white; mean [SD] weight gain: 9.7 kg [9.7 kg] over 34 years) were included in the analysis. For type 2 diabetes, the adjusted incidence per 100 000 person-years was 207 among women who gained a moderate amount of weight (≥2.5 kg to <10 kg) vs 110 among women who maintained a stable weight (weight loss ≤2.5 kg or gain <2.5 kg) (absolute rate difference [ARD] per 100 000 person-years, 98; 95% CI, 72 to 127) and 258 vs 147, respectively, among men (ARD, 111; 95% CI, 58 to 179); hypertension: 3415 vs 2754 among women (ARD, 662; 95% CI, 545 to 782) and 2861 vs 2366 among men (ARD, 495; 95% CI, 281 to 726); cardiovascular disease: 309 vs 248 among women (ARD, 61; 95% CI, 38 to 87) and 383 vs 340 among men (ARD, 43; 95% CI, -14 to 109); obesity-related cancer: 452 vs 415 among women (ARD, 37; 95% CI, 4 to 73) and 208 vs 165 among men (ARD, 42; 95% CI, 0.5 to 94). Among those who gained a moderate amount of weight, 3651 women (24%) and 2405 men (37%) achieved the composite healthy aging outcome. Among those who maintained a stable weight, 1528 women (27%) and 989 men (39%) achieved the composite healthy aging outcome. The multivariable-adjusted odds ratio for the composite healthy aging outcome associated with moderate weight gain was 0.78 (95% CI, 0.72 to 0.84) in women and 0.88 (95% CI, 0.79 to 0.97) in men. Higher amounts of weight gain were associated with greater risks of major chronic diseases and lower likelihood of healthy aging.

Conclusions And Relevance: In these cohorts of health professionals, weight gain during adulthood was associated with significantly increased risk of major chronic diseases and decreased odds of healthy aging. These findings may help counsel patients regarding the risks of weight gain.
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http://dx.doi.org/10.1001/jama.2017.7092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817436PMC
July 2017

Smoking during pregnancy in relation to grandchild birth weight and BMI trajectories.

PLoS One 2017 12;12(7):e0179368. Epub 2017 Jul 12.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.

Background: Maternal smoking has been linked to lower birth weight and higher risk of childhood obesity. However, it is unknown whether grand-maternal smoking during pregnancy is associated with grandchildren birth weight and body mass index (BMI) trajectories.

Methods: We investigated associations of smoking during pregnancy with birth weight, risks of overweight and BMI trajectories among 46,858 mother-child dyads and 6,583 grandmother-mother-child triads of three cohort studies of related individuals. Smoking during pregnancy was reported by mothers, and anthropometric data were provided by participants in each cohort.

Results: Compared to grandchildren of non-smoking women, grandchildren of women who smoked more than 14 cigarettes per day throughout pregnancy were 70 g (95% CI: 12, 129 g; P for trend = 0.01) heavier at birth, and 18% (95% CI: 4%, 34%; P for trend = 0.01) more likely to become overweight. The mean BMI of grandchildren of women who smoked during pregnancy was 0.45 kg/m2 (95% CI: 0.14, 0.75 kg/m2; P for trend = 0.006) higher through adolescence and young adulthood than that of grandchildren of non-smoking mothers.

Conclusions: Grandmothers' smoking during pregnancy was associated with higher birth weight, higher risk of overweight, and higher BMI through adolescence and young adulthood.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179368PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507479PMC
September 2017