Publications by authors named "Peijin Hu"

21 Publications

  • Page 1 of 1

National School-Based Health Lifestyles Intervention in Chinese Children and Adolescents on Obesity and Hypertension.

Front Pediatr 2021 28;9:615283. Epub 2021 May 28.

School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.

This study aimed to examine the effectiveness of the national school-based intervention on both obesity and high blood pressure in Chinese children and adolescents aged 6-18 years. The national school-based cluster non-randomized controlled trial was done in seven provinces from September 2013 to February 2014. A total of 23,175 children and adolescents in the control group and 25,702 in the intervention group were included in this trial with a mean follow-up of 6.7 ± 0.9 months. Mixed-effects regression models were used to evaluate the effect of the interventions on body weight and blood pressure (BP). A significant upward in the body mass index (BMI) levels but downward in systolic BP (SBP), diastolic BP (DBP), BMI -scores, SBP Z-scores, and DBP -scores were witnessed in the intervention group compared to those in the control group (<0.001). Subgroup analyses presented significant intervention effects in children aged 6-12 years for BMI, SBP, DBP, and their standardized values -scores, but no effective results were found in adolescents aged 13-18 years. Stratification analyses based on the dynamic weight changes presented non-differential HBP, SHBP, and DHBP prevalence gaps between the control and intervention groups. Children aged 6-12 years with higher BMI percentiles at baseline presented obvious declines in SBP and DBP standardized values -scores. A mean 6-month multi-centered school-based comprehensive obesity intervention in China yields a small to null effect on obesity and hypertension with increasing age; the early age before 12 years may be the key period for interventions, and the younger, the better. Precise and high-intensity interventions targeting the population at different stages of childhood and adolescence are urgently needed to be developed. https://www.clinicaltrials.gov/, identifier: NCT02343588.
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http://dx.doi.org/10.3389/fped.2021.615283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192970PMC
May 2021

Towards Comprehensive National Surveillance for Adolescent Health in China: Priority Indicators and Current Data Gaps.

J Adolesc Health 2020 11 24;67(5S):S14-S23. Epub 2020 Nov 24.

Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia.

Purpose: The purpose of the study was to propose a health indicator system responsive to current Chinese adolescent health needs and identify data gaps in current information systems.

Methods: We identified 186 keywords for adolescent health gathered from three sources: contributors to the burden of disease captured in the Global Burden of Diseases 2015, together with independent literature and expert desk reviews; major health-related policies released by the State Council of China; and global strategies issued by UN agencies over the past five years. All keywords were synthesized into indicators and ranked with core indicators identified through panel discussions and literature review. A further systematic review was conducted to identify data sources for each indicator.

Results: We identified 100 indicators which we categorized into five dimensions: health outcomes including adolescent mortality and morbidity; health knowledge, skills and risk behaviors including smoking, physical activity; demographic and socioeconomic status including education or employment; responsiveness of the health service system including the provision of health education at school; and the physical and social environments including safe drinking water, secondhand smoke exposure, injuries, and bullying. In total, 72 indicators had nationally representative data, including 22 out of 24 core indicators (91.7%), 27 out of 33 potential core indicators (81.8%), and 23 out of 43 general indicators (53.5%). A large proportion of these indicators rely solely on data from school or household surveys.

Conclusions: The proposed health indicator system has the potential to rapidly identify shifting priorities for adolescent health in China but will require greater investment in primary data collection in neglected areas.
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http://dx.doi.org/10.1016/j.jadohealth.2020.05.043DOI Listing
November 2020

The association between menarche and myopia and its interaction with related risk behaviors among Chinese school-aged girls: a nationwide cross-sectional study.

J Dev Orig Health Dis 2020 12 17;11(6):573-579. Epub 2020 Aug 17.

Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA.

Nearly 80% of new cases of myopia arise between 9 and 13 years old when puberty development also progresses rapidly. However, little is known about the association between myopia and puberty. We aim to evaluate the association between myopia and menarche, the most important puberty indicator for girls, and to test whether menarche could modify the effects of myopia-related behaviors. The participants came from two consecutive national surveys conducted in 30 provinces in mainland China in 2010 and 2014. We included 102,883 girls (61% had experienced menarche) aged 10-15 years. Risk behaviors for myopia which included sleep duration, homework time, and outdoor activity were measured by self-administrated questionnaire. Myopia was defined according to a validated method, and its relationships with menarche status and behaviors were evaluated by robust Poisson regression models based on generalized estimated equation adjusting for cluster effect of school. We found that postmenarche girls were at 13% (95% confidence interval: 11%-16%) higher risk of myopia than premenarche girls, after adjusting for exact age, urban-rural location, survey year, and four behavioral covariates. Short sleep duration (<7 h/d), long homework time (>1 h/d) and low frequency of weekend outdoor activity tended to be stronger (with higher prevalence ratios associated with myopia) risk factors for myopia in postmenarche girls than in premenarche girls, and their interaction with menarche status was all statistically significant (P < 0.05). Overall, our study suggests that menarche onset may be associated with increased risk of myopia among school-aged girls and could also enhance girls' sensitivity to myopia-related risk behaviors.
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http://dx.doi.org/10.1017/S204017442000077XDOI Listing
December 2020

National and Subnational Trends in Mortality and Causes of Death in Chinese Children and Adolescents Aged 5-19 Years From 1953 to 2016.

J Adolesc Health 2020 11 19;67(5S):S3-S13. Epub 2020 Jul 19.

Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia.

Purpose: We aimed to analyze the recent trends of mortality and rankings of causes of death in Chinese children and adolescents from 1953 to 2016.

Methods: Data on mortality and causes of death in Chinese children and adolescents aged 5-19 years were extracted from the China Health Statistics Yearbook and the Global Burden of Disease Study from 1953 to 2016. Mortality variations were analyzed by year, age, sex, province, and causes of death.

Results: The mortality of Chinese children and adolescents aged 5-19 years declined steadily from 1953 (366.03/100,000) to 2016 (27.21), with the largest reduction in adolescents aged 15-19 years and the smallest reduction in those aged 10-14 years. Large subnational disparities for all-cause mortality existed in national 31 provinces with higher mortality in western regions compared with eastern regions, but with narrowing disparities between 1981 and 2010. Injuries dominated the causes of death compared with noncommunicable diseases and communicable, maternal and neonatal, and nutritional diseases from 1990 (58.13/100,000 vs. 32.10 and 14.31) to 2016 (22.65 vs. 13.00 and 2.93). In 2016, the leading three causes of death were road injuries (8.30/100,000), drowning (7.25), and leukemia (2.60). Drowning was the leading cause of death for 5- to 14-year-olds, but road injuries have been the leading cause for 15- to 19-year-olds of both sexes since 2010.

Conclusions: Although mortality in Chinese adolescents now stands at just 7% of rates in the 1950s, there is a need to address continuing inequalities across sex, economic status, and region.
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http://dx.doi.org/10.1016/j.jadohealth.2020.05.012DOI Listing
November 2020

The mean age of menarche among Chinese schoolgirls declined by 6 months from 2005 to 2014.

Acta Paediatr 2021 02 9;110(2):549-555. Epub 2020 Jul 9.

Department of Sport & Physical Education, Hong Kong Baptist University, Hong Kong, China.

Aim: This study assessed the trends in the age at menarche in Chinese schoolgirls from the majority Han group and 21 ethnic minorities from 2005 to 2014. We also compared the group differences during the study period.

Methods: A total of 344 230 girls aged 9-18 years were extracted from the 2005, 2010 and 2014 Chinese National Survey on Students' Constitution and Health. The age at menarche for each subgroup was estimated by probit analysis. The chi-square test and Z-test were used to compare the differences between the groups.

Results: The overall average age at menarche in Chinese schoolgirls decreased from 12.8 years in 2005 to 12.3 years in 2014. The Han girls and girls from 17 ethnic minorities showed decreasing trends in the age at menarche, while four ethnic minorities demonstrated fluctuating increasing trends over time. The gaps in age at menarche between the Han group and 14 of the ethnic minorities became smaller over the study period and were similar by 2014.

Conclusion: The overall findings were a decrease in the age at menarche in China and smaller gaps between the majority Han group and ethnic minority groups. Ethnic-specific public health policies are urgently needed on issues such as contraception.
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http://dx.doi.org/10.1111/apa.15441DOI Listing
February 2021

Ethnicity, socioeconomic status and the nutritional status of Chinese children and adolescents: Findings from three consecutive national surveys between 2005 and 2014.

Pediatr Obes 2020 11 15;15(11):e12664. Epub 2020 Jun 15.

Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.

Background: Economic development has brought rapid shifts in the food environment of Chinese children and adolescents.

Objectives: To assess the changes in childhood nutritional status across ethnic groups and economic status from 2005 to 2014.

Methods: 664 094 Chinese Han and 224 151 ethnic minority children and adolescents aged 7 to 18 years were assessed in three national cross-sectional surveys (2005, 2010 and 2014). Gross domestic product (GDP) per capita of each ethnic group was categorized into four strata of socioeconomic status. To assess ethnic disparities at each time point, we used logistic regression to estimate the prevalence odds ratios (OR) for thinness, overweight and obesity in the 24 ethnic minority groups vs Han Chinese.

Results: Children in the two upper economic strata (over about US$4000 GDP per capita) had a high prevalence of overweight and obesity, while those in the two lower economic strata (below US$4000 GDP per capita) had a high prevalence of thinness. From 2005 to 2014, the prevalence of thinness decreased from 18.6% to 13.1% in Han children, and from 20.4% to 17.1% in ethnic minority students. At the same time, the prevalence of overweight and obesity increased from 10.4% to 17.7% in Han children, and from 4.3% to 9.2% in ethnic minority students, respectively.

Conclusions: A rapid nutritional transition has occurred from 2005 to 2014 with shifts from thinness to overweight and obesity in both Han and ethnic minority children and adolescents, reflecting local GDP per capita.
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http://dx.doi.org/10.1111/ijpo.12664DOI Listing
November 2020

Comprehensive physical fitness and high blood pressure in children and adolescents: A national cross-sectional survey in China.

J Sci Med Sport 2020 Sep 5;23(9):800-806. Epub 2020 Mar 5.

Institute of Child and Adolescent Health, School of Public Health, Peking University, China. Electronic address:

Objectives: To assess the association between comprehensive physical fitness and high blood pressure (HBP) among Chinese children and adolescents.

Design: National cross-sectional surveys.

Methods: 214,301 school students' data aged 7-18years was extracted in 2014. Six components of physical fitness (forced vital capacity, standing long jump, sit-and-reach, body muscle strength, 50m dash and endurance running) were measured, standardized and aggregated as a summary physical fitness indicator (PFI). HBP, systolic HBP (SHBP) and diastolic HBP (DHBP) were defined according to sex-, age- and height-specific references in China.

Results: The prevalence of HBP, SHBP and DHBP was 8.6%, 4.7% and 5.7%, respectively, and PFI was -0.9 in Chinese children and adolescents. A significant negative association between the PFI and HBP was observed with adjusted prevalence of HBP (10.8% (95% CI: 10.4-11.2) to 7.6% (95% CI: 7.3-8.0), P<0.001), SHBP (5.7% (95% CI: 5.4-6.1) to 4.4% (95% CI: 4.1-4.6), P<0.001), and DHBP (7.6% (95% CI: 7.2-7.9) to 4.6% (95% CI: 4.3-4.9), P<0.001) and their ORs (HBP: 0.87(95% CI: 0.82-0.93) to 0.68(95% CI: 0.64-0.73), P<0.001; SHBP: 0.86(95% CI: 0.79-0.94) to 0.75(95% CI:0.69-0.82), P<0.001; DHBP: 0.85(95% CI: 0.79-0.92) to 0.59(95% CI: 0.54-0.64), P<0.001) declined with the increase in PFI. Stratified nutritional status exhibited a similar negative association between PFI and HBP, SHBP and DHBP in children with normal weight, overnutrition, and undernutrition. Stand long jump, body muscle strength, 50m dash, and endurance running, had a negative association with HBP, SHBP and DHBP, but forced vital capacity had a positive such association. Sit-and-reach and HBP are not significantly associated.

Conclusions: Physical fitness was negatively correlated to the increased HBP in children and adolescents. Comprehensive policies and measures to enhance children and adolescents' physical fitness are urgently needed through the promotion of physical activity, healthy dietary patterns, and strategies of educational guidelines to reduce schoolwork, which will in turn reduce the cardiovascular burdens in the future.
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http://dx.doi.org/10.1016/j.jsams.2020.02.016DOI Listing
September 2020

Prevalence of Anemia and its Associated Factors among Chinese 9-, 12-, and 14-Year-Old Children: Results from 2014 Chinese National Survey on Students Constitution and Health.

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

Institute of Child and Adolescent Health & School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian Dsictrict, Beijing 100191, China.

: Anemia has been one of the main nutritional challenges around the world. Not enough attention has been paid to this issue in children and adolescents in China. In this study, we aimed to estimate the prevalence of anemia among 9-, 12-, and 14-year old Chinese children and investigate the associated factors of anemia. Data come from a cross-sectional survey conducted in 26 provinces and 4 municipalities in mainland China. A total of 48,537 children aged 9, 12, and 14 years old were included in data analyses. Anthropometric measurements were conducted to obtain information about height and weight. Capillary blood was collected from the fingertip, and hemoglobin concentration was tested by HemoCue201+. Information about sleep duration, daily consumption of eggs, milk, and breakfast were obtained from a self-administrated questionnaire. The mixed-effects logistic regression model was applied to estimate the association between selected variables and risk of anemia. A total of 8.4% of participants were identified as being anemic; and the prevalence was higher in girls and rural children. Mixed-effects logistic regression analysis showed that children who were overweight, obese, and consumed eggs and milk every day had a lower risk of anemia. Spermarche, overweight/obesity, and having milk every day were associated with lower risk of anemia in boys, while menarche was found to be a risk factor and eating eggs every day to be a protective factor of anemia in girls. Anemia among 9-, 12-, and 14-year-old children is still high. Intervention programs of adding egg and milk into school daily diet might contribute to reducing anemia in Chinese school aged children, especially for those living in rural areas or girls with menarche.
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http://dx.doi.org/10.3390/ijerph17051474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084637PMC
February 2020

The associations of economic growth and anaemia for school-aged children in China.

Matern Child Nutr 2020 04 13;16(2):e12936. Epub 2020 Jan 13.

Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.

Economic growth has brought improvements in many areas of child health, but its effects on anaemia among school-aged children remain unknown. However, this is important because iron deficiency anaemia is common and is the main cause of disability-adjusted life years for school-aged children. In this study, we included 429,222 Chinese children aged 7-17 years from five consecutive national cross-sectional surveys during 1995-2014. Using altitude-adjusted haemoglobin concentration measured from capillary blood samples, we defined anaemia status according to World Health Organization's recommendation. We used logistic regressions weighted by provincial population to examine the association between provincial gross domestic product (GDP) per capita and anaemia, adjusting for sex, age, urban-rural location, regional socio-economic status (SES), fixed effect of province, and clustering of schools. We used generalised additive mixed models to evaluate a potentially non-linear relationship. For each 100% growth in GDP per capita, there was a 40% (odds ratio [OR] = 0.60; 95% confidence interval [CI; 0.56, 0.65]) reduction in anaemia. However, the association was weaker for girls and in cities with a lower SES. The association was weaker across 2005-2014 (OR = 0.75, 95% CI [0.62, 0.90]) compared with 1995-2005 (OR = 0.52; 95% CI [0.44, 0.61]), reflecting a weaker association when GDP per capita reaches around $2,000. The results were similar for moderate-to-severe anaemia. We concluded that economic growth has been associated with reductions in anaemia among school-aged children in China but with fewer benefits for girls and those in poorer settings. Further economic development in China is unlikely to bring similar reductions in anaemia, suggesting that additional population level and targeted interventions will be needed.
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http://dx.doi.org/10.1111/mcn.12936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083510PMC
April 2020

Trends in physical fitness, growth, and nutritional status of Chinese children and adolescents: a retrospective analysis of 1·5 million students from six successive national surveys between 1985 and 2014.

Lancet Child Adolesc Health 2019 12 30;3(12):871-880. Epub 2019 Sep 30.

Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia.

Background: Physical fitness is strongly associated with health. Despite the extent of the nutritional transition from food scarcity to diets high in fats and refined carbohydrates that has occurred in China, to our knowledge, trends in physical fitness have not been described. We aimed to assess trends in physical fitness and its association with the nutritional transition among Chinese children and adolescents.

Methods: In this retrospective analysis, data from Chinese school students aged 7-18 years were extracted from six successive national surveys undertaken between 1985 and 2014. Six components of physical fitness (forced vital capacity, standing long jump, sit-and-reach, body muscle strength, 50 m dash, and endurance running) were measured repeatedly in each survey and aggregated as a summary physical fitness indicator (PFI). Growth and nutritional status (stunting, thinness, normal weight, overweight, and obesity) were defined by use of WHO definitions, and we combined stunting and thinness as undernutrition and overweight and obesity as overnutrition. Urbanisation levels were obtained from the statistical yearbook of the National and Provincial Bureau of Statistics of China. We used fractional polynomial regression and generalised additive models to assess associations between PFI and nutritional outcomes and between PFI and levels of urbanisation.

Findings: Between 1985 and 2014, 1 513 435 students participated in the Chinese National Survey on Students' Constitution and Health, and 1 494 485 were included in our study. We observed a decline of the PFI during 1985-2014 (overall PFI change -0·8), albeit with an increase from 1985 to 1995 (PFI change 1·2), coinciding with a shift in the major nutritional problems from stunting and thinness to overweight and obesity. Both undernourished (PFI -2·44 for thin and -3·42 for stunting) and overnourished (-1·49 for overweight and -3·63 for obese) students had a lower PFI than that of those with normal weight (-0·41) in 2014. Boys had a larger decline in PFI than girls in 1985-2014, especially boys with obesity (PFI change -2·7). We observed the highest PFI in 1995 (1·17), when the proportion of students with normal weight was highest. Advancing urbanisation was accompanied by declines in physical fitness, which occurred in both students in rural settings and those in urban settings in these regions.

Interpretation: Our study supports the continuation of policies to improve physical fitness that focus on undernutrition, including economic subsidies, in poorer rural regions. However, for most of China, taxation of unhealthy foods, promotion of physical activity, reduction in academic pressures, promotion of dietary diversity, reduction of sedentary time, and engagement in formal sporting activities should be elements of policies to promote healthy weight status and prevent obesity in school students, which will also support physical fitness.

Funding: National Natural Science Foundation, Humanities and Social Sciences Planning Fund Project, China Scholarship Council, and Innovation Fund for Outstanding Doctoral Candidates of Peking University Health Science Center.
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http://dx.doi.org/10.1016/S2352-4642(19)30302-5DOI Listing
December 2019

Secular Trends of Ascariasis Infestation and Nutritional Status in Chinese Children From 2000 to 2014: Evidence From 4 Successive National Surveys.

Open Forum Infect Dis 2019 May 23;6(5):ofz193. Epub 2019 Apr 23.

Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.

Background: This study aimed to assess secular trends and epidemiological status of ascariasis infestations and to explore its effects on the nutritional transition among Chinese children from 2000 to 2014.

Methods: Data were collected from 69 435 Chinese children aged 7-year-olds and 9-year-olds in 4 successive cross-sectional surveys of Chinese National Survey on Students' Constitution and Health. Ascariasis infestation was defined by using the Kato-Katz method. Nutritional status was classified into stunting, thinness, overweight, and obesity by WHO definition.

Results: From 2000 to 2014, the ascariasis infestation rates decreased from 9.1% to 1.7%, the stunting and thinness prevalence decreased from 4.3% and 13.8% to 0.7% and 7.1%, while the overweight and obesity prevalence increased from 3.6% and 2.1% to 9.8% and 9.1%, respectively. Compared to children in the ascariasis noninfestation group, those infected with ascariasis had a worse nutritional status. Yet, the disparity in nutritional status between 2 groups disappeared over time. Provinces with a higher gross domestic product per capita simultaneously had lower ascariasis infestation rates, lower stunting and thinness prevalence, and higher overweight and obesity prevalence.

Conclusions: The retardation effects caused by ascariasis infestation on nutritional status in Chinese children seemed to be offset by the rapid economic development and nutritional transition over time; nevertheless, multiple prevention and control measures are still needed and should be continuously strengthened.
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http://dx.doi.org/10.1093/ofid/ofz193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527090PMC
May 2019

Geographical variation and urban-rural disparity of overweight and obesity in Chinese school-aged children between 2010 and 2014: two successive national cross-sectional surveys.

BMJ Open 2019 04 3;9(4):e025559. Epub 2019 Apr 3.

Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.

Purpose: The urban-rural disparity for childhood overweight and obesity shows different patterns in most countries. This study aimed to examine the recent trend of urban-rural disparity for childhood overweight and obesity at national and subnational levels in Chinese children from 2010 to 2014.

Design: Two successive national cross-sectional studies. Overweight and obesity were classified using Chinese national age-specific and sex-specific body mass index reference. The prevalence of overweight and obesity was compared between urban and rural areas at national and subnational levels.

Setting: Thirty-one provinces in China.

Participants: Data were obtained from the Chinese National Survey on Students' Constitution and Health in 2010 and 2014 with 215 214 (107 741 in 2010 and 107 473 in 2014) children aged 7-12 years.

Results: The overweight and obesity prevalence increased from 17.1% in 2010 to 22.5% in 2014. The overweight and obesity prevalence in both urban and rural areas was higher in the eastern provinces but lower in the western provinces. The urban-rural disparity in overweight and obesity decreased steadily from 2010 to 2014 (1.79 to 1.42 for prevalence OR). There was greater urban-rural disparity in western China than eastern China. A reversal occurred in 2014 in several eastern provinces where the overweight and obesity prevalence in rural children surpassed that of their urban peers.

Conclusions: A narrowing urban-rural disparity and the reversal signal between urban and rural areas in overweight and obesity would contribute to a growing proportion of obese children in rural areas. Therefore, urgent region-specific policies and interventions with a forward-looking approach should be considered for Chinese children, especially in rural areas.
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http://dx.doi.org/10.1136/bmjopen-2018-025559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500219PMC
April 2019

Subnational variation of stunting, wasting and malnutrition in Chinese primary-school children between 2010 and 2014: urban-rural disparity.

Public Health Nutr 2019 08 4;22(11):2043-2054. Epub 2019 Mar 4.

1Institute of Child and Adolescent Health,School of Public Health,Peking University,38 Xue Yuan Road,Haidian District,Beijing 100191,People's Republic of China.

Objective: To examine urban-rural disparity in childhood stunting, wasting and malnutrition at national and subnational levels in Chinese primary-school children in 2010 and 2014.

Design: Data were obtained from two nationwide cross-sectional surveys conducted in 2010 and 2014. Malnutrition was classified using the Chinese national 'Screening Standard for Malnutrition of Children'.

Setting: All twenty-seven mainland provinces and four municipalities of mainland China.ParticipantsChildren aged 7-12 years (n 215 214; 107 741 in 2010 and 107 473 in 2014) from thirty-one provinces.

Results: Stunting, wasting and malnutrition prevalence were 1·9, 12·3 and 13·7 % in 2010, but decreased to 1·0, 9·4 and 10·2 % in 2014, respectively. The prevalence of stunting, wasting and malnutrition in both urban and rural children was higher in western provinces, while lower in eastern provinces. Although the prevalence of wasting and malnutrition was higher in rural children than their urban counterparts, the urban-rural disparity in both wasting and malnutrition decreased from 2010 to 2014 (prevalence OR: wasting, 1·35 to 1·16; malnutrition, 1·50 to 1·27). A reversal occurred in 2014 in several eastern provinces where the prevalence of wasting and malnutrition in urban children surpassed their rural peers. The urban-rural disparity was larger in western provinces than eastern provinces.

Conclusions: The shrinking urban-rural disparity and the reversal in wasting and malnutrition suggest that the malnutrition situation has improved during the post-crisis period, especially in the western provinces. Region-specific policies and interventions can be useful to sustainably mitigate malnutrition in Chinese children, especially in rural areas and the western provinces.
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http://dx.doi.org/10.1017/S1368980019000235DOI Listing
August 2019

Secular trends in age at menarche among Chinese girls from 24 ethnic minorities, 1985 to 2010.

Glob Health Action 2015 27;8:26929. Epub 2015 Jul 27.

Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.

Background: Declining age at menarche has been observed in many countries. In China, a decrease of 4.5 months per decade in the average age at menarche among the majority Han girls has recently been reported. However, the trends in age at menarche among ethnic minority girls over the past 25 years remain unknown.

Objectives: To compare the differences in median age at menarche among girls aged 9-18 years across 24 ethnic minorities in 2010 and to estimate the trends in age at menarche in different ethnic minorities from 1985 to 2010.

Design: We used data from six cross-sectional Chinese National Surveys on Students' Constitution and Health (1985, 1991, 1995, 2000, 2005, and 2010). The median age at menarche was estimated by using probit analysis.

Results: In 2010, the ethnic minorities with the earliest age at menarche were the Koreans (11.79 years), Mongolians (12.44 years), and Zhuang (12.52 years). The three ethnic minorities with the latest age at menarche were the Sala (14.32 years), Yi (13.74 years), and Uighurs (13.67 years). From 1985 to 2010, the age at menarche declined in all 24 minority groups. The Lisu, Kazakh, and Korean minorities showed the largest reductions in age at menarche by 1.79 (p<0.05), 1.69 (p<0.05), and 1.57 (p<0.05) years, respectively, from 1985 to 2010. The Yi, Sala, and Li minorities showed the smallest reductions, with age at menarche declining by only 0.06 (p>0.05), 0.15 (p>0.05), and 0.15 (p>0.05) years, respectively, in the same period.

Conclusion: A large variation in age at menarche was observed among different ethnic minorities, with the earliest age at menarche found among Korean girls. A reduction in the average age at menarche appeared among most of the ethnic minorities over time, and the largest decrease was observed in Lisu, Kazakh, and Korean girls. Thus, health education should focus on targeting the specific needs of each ethnic minority group.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518164PMC
http://dx.doi.org/10.3402/gha.v8.26929DOI Listing
March 2016

Secular trends of obesity prevalence in Chinese children from 1985 to 2010: Urban-rural disparity.

Obesity (Silver Spring) 2015 Feb 17;23(2):448-53. Epub 2014 Dec 17.

Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China; Division of Social Medicine and Global Health, Faculty of Medicine, Lund University, Lund, Sweden.

Objective: To examine the trend of urban-rural disparity in obesity prevalence among Chinese children from 1985 to 2010.

Methods: The data were from five cross-sectional surveys (1985, 1995, 2000, 2005, and 2010) of Chinese National Surveys on Students' Constitution and Health. Logistic regression was used to estimate the prevalence odds ratio (POR) of urban-rural areas for obesity prevalence in different surveys.

Results: The standardized prevalence of obesity in Chinese children increased rapidly from 0.1% in 1985 to 5.0% in 2010, and significant differences were found between two adjacent surveys in most of the age subgroups (P<0.01). Although the obesity prevalence was significantly higher in urban than in rural children of all age subgroups at different survey points, the changing pace was faster in rural than in urban areas from 1995 to 2010. The PORs had increased in 1995 in most age subgroups and then began to decline in all age subgroups after 1995.

Conclusions: The gradually decreasing urban-rural disparity suggests that the obesity prevalence in rural areas would contribute to a growing proportion of obese children. Therefore, rural children should be included in obesity prevention efforts even though obesity rates are still lower in rural than in urban areas.
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http://dx.doi.org/10.1002/oby.20938DOI Listing
February 2015

[Current situation of sleeping duration in Chinese Han students in 2010].

Zhonghua Yu Fang Yi Xue Za Zhi 2014 Jul;48(7):596-601

The Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China. Email:

Objective: To analyze the characteristics of sleep duration in Chinese primary and middle school students.

Methods: The data was collected from 30 provinces (Autonomous regions, Municipalities) in 165 363 Han Primary school students above 4 grade, the junior and senior high school students who participated in 2010 National Physical Fitness and Health Surveillance by using stratified random cluster sampling method, and the questionnaire of sleep duration, insufficient sleep and commuting way from school was conducted at the same time.χ² test and χ² linear-by-linear test were used to analyze the difference between the different groups, and logistic regression was used to analyze the factors of insufficient sleep.

Results: Nationwide in 2010, 39.09% (64 646/165 363) of students reported they had more than 8 hours sleep duration per day, the prevalence was lower among urban (37.06% (30 767/83 027)) than rural (41.15% (33 879/82 336)) students (χ² = 290.53, P < 0.01), and higher among boys (40.25% (33 193/82 446)) than girls (37.94% (31 453/82 897)) (χ² = 92.51, P < 0.01). The prevalence of having more than 8 hours sleep duration per day in 9-12 years group, 13-15 years group and 16-18 years group was 70.24% (43 934/62 549), 31.31% (16 166/51 652) and 8.89% (546/51 162), respectively, and decreased with the age increasing (χ² linear-by-linear = 50 617.75, P < 0.01). The prevalence of insufficient sleep was 93.64% (154 838/165 363) in total students, the prevalence was higher among urban (94.94% (78 829/83 027)) than rural students (92.32% (76 009/82 336)) (χ² = 479.14, P < 0.01), and lower among boys (92.65% (76 408/82 466) than girls 94.61% (78 430/82 897) (χ² = 265.79, P < 0.01). The prevalence of insufficient sleep in 9-12 years group, 13-15 years group and 16-18 years group was 96.42% (60 310/62 549), 92.76% (47 912/51 562) and 91.11% (46 616/51 162), respectively. A multivariate logistic regression analysis (OR (95% CI)) revealed that the insufficient sleep was significantly associated with being urban (1.58 (1.51-1.65)), being girls (1.39 (1.34-1.45)), being 9-12 years group (2.77 (2.62-2.93)), living in the middle (1.19 (1.13-1.25)) or western (1.08 (1.03-1.13)) of China, and commuting from school by bicycle (1.21 (1.14-1.28)), bus/car (1.09 (1.03-1.15)), or in a boarding school (1.17 (1.10-1.24)).

Conclusion: The sleep duration in Chinese school children is low, a sizeable proportion of school children sleep less than the recommended hours. The prevalence of insufficient sleep is high, and there are significant differences in different groups.
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July 2014

Trends of age at menarche and association with body mass index in Chinese school-aged girls, 1985-2010.

J Pediatr 2014 Dec 17;165(6):1172-1177.e1. Epub 2014 Sep 17.

Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.

Objectives: To estimate the shifts in age at menarche from 1985 to 2010, compare the differences of average age at menarche between urban and rural groups, and determine the association of menarche with body mass index (BMI).

Study Design: The data were obtained from 4 cross-sectional Chinese National Surveys on Students' Constitution and Health (1985, 1995, 2005, and 2010). In this representative sample of Chinese school-aged girls, the average age at menarche was determined using probit analysis and compared between urban and rural areas. Logistic regression was used to assess the association of BMI with the likelihood of having reached menarche.

Results: The age at menarche in Chinese girls dropped from 13.41 years to 12.47 years from 1985 to 2010. There was a significant difference in age at menarche between urban and rural girls over time, with urban girls having their menarche earlier than rural girls. Logistic regression showed that a higher BMI was strongly associated with an increased likelihood of having reached menarche, even after controlling for age, urban or rural residence, province, social economic status, and school.

Conclusion: The analysis suggests a drop of about 4.5 months per decade in the average age at menarche over the past 25 years, and a significant inverse association between BMI and having reached menarche. Considering that both early menarche and higher BMI are significant risk factors for chronic diseases, and may act together in later years to the detriment of a woman's health, greater attention should be paid to the health of girls with earlier menarche and higher BMI.
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http://dx.doi.org/10.1016/j.jpeds.2014.08.013DOI Listing
December 2014

BMI-for-age Z-score distribution shifts among Chinese children: gender disparity.

Obesity (Silver Spring) 2014 Apr 19;22(4):1187-93. Epub 2013 Dec 19.

Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.

Objective: To identify gender differences among Chinese school-aged children from 1995 to 2010, and to project the future BMI-for-age Z-score distribution and prevalence of obesity.

Methods: The data were from four cross-sectional surveys (1995, 2000, 2005, and 2010) of Chinese National Surveys on Students Constitution and Health (CNSSCH) with a national representative sample of Chinese children, involving more than 200,000 participants at each survey. BMI-for-age Z-score distributional shifts overall and in percentiles were compared by gender. Average shift was calculated for four survey periods and used for projecting future distributions and obesity prevalence.

Results: BMI-for-age Z-score increased more in their upper percentile distribution, indicating that Chinese children have become heavier over the past 15 years. Gender disparity in BMI-for-age Z-score has become wider during the period. Over a 15-year period, BMI-for-age Z-score shift among girls has been stable, while boy's BMI-for-age Z-score shifts has increased linearly. By 2020, the obesity prevalence is predicted to be 10.18% and 4.99% for boys and girls, respectively.

Conclusions: The wider gender disparity suggested a larger proportion of obesity in boys than in girls. Therefore, gender-specific preventive guidelines and public health policies for childhood obesity and cardiovascular diseases are urgently needed in China.
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http://dx.doi.org/10.1002/oby.20676DOI Listing
April 2014

Body fat and blood pressure: comparison of blood pressure measurements in Chinese children with different body fat levels.

Br J Nutr 2012 Nov 16;108(9):1672-7. Epub 2012 Jan 16.

Institute of Child and Adolescent Health, School of Public Health, Peking University Health Sciences Center, 38 Xueyuan Road, Haidian District, Beijing, People's Republic of China.

Children in China are experiencing a rapid increase in the prevalence of obesity, which is associated with hypertension. To compare the effect of body fat on blood pressure (BP) with that of the normal physical growth, we compared BP levels in Chinese children with different body fat levels. In the present population-based study, 13 972 children in the highest-skinfold-thickness-quartile group were individually matched to 13 972 children in the lowest-skinfold-thickness-quartile group by height and weight. Similarly, 5103 children in the highest-waist-circumference-quartile group were matched to the same number of children in the lowest-waist-circumference-quartile group. The high- and low-fat groups had similar height and weight but the high-fat group had significantly higher skinfold and waist circumference measurements. The differences in systolic BP (SBP) between the high- and low-skinfold-thickness groups were small: 0·01 (95 % CI -0·41, 0·44) mmHg in boys and 0·20 (95 % CI -0·15, 0·54) mmHg in girls. The differences in diastolic BP (DBP) were also small (0·39 and 0·38 mmHg for boys and girls, respectively) but were statistically significant. The differences in both SBP and DBP between the high- and low-waist-circumference groups were small but not statistically significant. For a given body size as measured by height and weight, relative body fat had little impact on BP levels in these children. Fat mass and lean mass may have a similar quantitative impact on BP in healthy-weight children.
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http://dx.doi.org/10.1017/S0007114511007136DOI Listing
November 2012

Quantifying the relationships of blood pressure with weight, height and body mass index in Chinese children and adolescents.

J Paediatr Child Health 2012 May 3;48(5):413-8. Epub 2011 Nov 3.

Institute of Child and Adolescent Health, School of Public Health, Peking University Health Sciences Center, Beijing, China.

Aim: The aim of this study was to quantify the relationships of height, weight and body mass index (BMI) with blood pressure (BP) levels in Chinese children and adolescents.

Methods: Height, weight, BMI and BP measurements were obtained from a nationally representative sample of 231,227 children aged 7-18 years. Body size measurements were converted to age- and sex-specific standard deviation (SD) scores. The relationships between body size and BP measurements were assessed using linear regression analysis.

Results: All body size measurements were significantly associated with BP levels. Systolic BP increased 4.14, 3.70 and 2.88 mmHg in boys and 2.98, 2.63 and 1.87 mmHg in girls, corresponding to 1 SD increase in weight, BMI and height, respectively. A similar pattern was also observed for diastolic BP. After adjustment for height, systolic BP increased substantially with increasing weight (3.96 mmHg/SD increase for boys and 2.92 mmHg for girls). With adjustment for weight, systolic BP increased slightly with 1 SD increase in height (0.27 mmHg for boys and 0.10 mmHg for girls). The strength of the association between a body size measurement and BP varied among different ages, peaked at 10-11 years in girls and around 12-14 years in boys.

Conclusions: Weight is the most powerful driving force of BP in children and adolescents, followed by BMI and height. Height has little impact on BP in children with a given weight, while weight has considerable impact on BP in children with a given height.
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http://dx.doi.org/10.1111/j.1440-1754.2011.02221.xDOI Listing
May 2012

BMI percentile curves for Chinese children aged 7-18 years, in comparison with the WHO and the US Centers for Disease Control and Prevention references.

Public Health Nutr 2010 Dec 1;13(12):1990-6. Epub 2010 Apr 1.

Institute of Child and Adolescent Health, School of Public Health, Peking University Health Sciences Center 38 Xueyuan Road, Haidian District Beijing 100191, People's Republic of China.

Objective: To establish BMI percentile curves that describe the contemporary BMI distribution among Chinese children, and to compare their BMI percentile curves with those in two recently developed international references: the WHO and the US Centers for Disease Control and Prevention (US CDC) growth references.

Design: A cross-sectional national survey.

Setting: Thirty provinces, municipalities and autonomous regions in China.

Subjects: Nationally representative sample of 232 140 school students aged 7-18 years.

Results: BMI percentile curves were established using the LMS method, and were compared with the percentiles of the WHO and the US CDC references. BMI distributions and growth patterns in Chinese children were dramatically different from those in the two international reference populations. Compared with the international reference populations, younger Chinese boys (7-12 years of age) had higher values of the percentiles above the median and lower values of the percentiles below the median, suggesting that they had larger proportions of extreme BMI values in both directions. Chinese girls and older Chinese boys (15-18 years of age) had substantially lower BMI percentiles than their counterparts in the reference populations, particularly those high percentiles among older age groups.

Conclusions: The present study described the unique patterns of BMI curves at the national level, and these curves are useful as a reference for comparing different regions and for monitoring changes over time in Chinese children. Higher proportions of children with extreme values in both directions indicate that China is currently facing both an increasing level of obesity and a high level of undernutrition, simultaneously.
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http://dx.doi.org/10.1017/S1368980010000492DOI Listing
December 2010
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