Publications by authors named "Yanhui Dong"

44 Publications

Association between pubertal development and elevated blood pressure in children.

J Clin Hypertens (Greenwich) 2021 Jul 3. Epub 2021 Jul 3.

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

Blood pressure (BP) increased with age and height development, but little was known about the effect of pubertal development on blood pressure in children. A cross-sectional study was performed among 4146 children aged 7-12 years old in China. Pubertal development was assessed based on breast stages and testicular volume. The associations of pubertal development with BP levels and the rate of elevated blood pressure (EBP) were quantified using multiple linear and logistic regressions. We found that pubertal developmental level was positively correlated with BP, and children who experienced puberty onset and early pubertal timing had higher BP levels and prevalence of EBP. After adjusting for covariates, children experienced puberty onset had 3.84 and 2.24 mmHg increase in systolic blood pressure and diastolic blood pressure, and 70%, 53%, and 62% increased odds of EBP, ESBP, and EDBP, respectively, compared with those without puberty onset. Similar results were observed for children who had early pubertal timing. The change of BP in puberty is greater and the association between pubertal development and BP is stronger in girls than boys. These findings suggested that pubertal development could be an important independent factor and one critical period for the EBP progress. Monitoring and management of pubertal development are necessary particularly among girls.
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http://dx.doi.org/10.1111/jch.14315DOI Listing
July 2021

Sex differences in the associations between adiposity distribution and cardiometabolic risk factors in overweight or obese individuals: a cross-sectional study.

BMC Public Health 2021 06 26;21(1):1232. Epub 2021 Jun 26.

Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, 4111, Australia.

Background: We aimed to assess the associations between adiposity distribution and cardiometabolic risk factors among overweight and obese adults in China, and to demonstrate the sex differences in these associations.

Methods: A total of 1221 participants (455 males and 766 females) were included in this study. Percentage of body fat (PBF) of the whole body and regional areas, including arm, thigh, trunk, android, and gynoid, were measured by the dual-energy X-ray absorptiometry method. Central adiposity was measured by waist circumference. Clustered cardiometabolic risk was defined as the presence of two or more of the six cardiometabolic risk factors, namely, high triglyceride, low high density lipoprotein, elevated glucose, elevated blood pressure, elevated high sensitivity C-reactive protein, and low adiponectin. Linear regression models and multivariate logistic regression models were used to assess the associations between whole body or regional PBF and cardiometabolic risk factors.

Results: In females, except arm adiposity, other regional fat (thigh, trunk, android, gynoid) and whole-body PBF are significantly associated with clustered cardiometabolic risk, adjusting for age, smoking, alcohol drinking, physical activity, and whole-body PBF. One-SD increase in Z scores of the thigh and gynoid PBF were significantly associated with 80 and 78% lower odds of clustered cardiometabolic risk (OR: 0.20, 95%CI: 0.12-0.35 and OR: 0.22, 95%CI: 0.12-0.41). Trunk, android and whole-body PBF were significantly associated with higher odds of clustered risk with OR of 1.90 (95%CI:1.02-3.55), 2.91 (95%CI: 1.75-4.85), and 2.01 (95%CI: 1.47-2.76), respectively. While in males, one-SD increase in the thigh and gynoid PBF are associated with 94% (OR: 0.06, 95%CI: 0.02-0.23) and 83% lower odds (OR: 0.17, 95%CI: 0.05-0.57) of clustered cardiometabolic risk, respectively. Android and whole-body PBF were associated with higher odds of clustered cardiometabolic risk (OR: 3.39, 95%CI: 1.42-8.09 and OR: 2.45, 95%CI: 1.53-3.92), but the association for trunk PBF was not statistically significant (OR: 1.16, 95%CI: 0.42-3.19).

Conclusions: Adiposity distribution plays an important role in the clustered cardiometabolic risk in participants with overweight and obese and sex differences were observed in these associations. In general, central obesity (measured by android PBF) could be the best anthropometric measurement for screening people at risk for CVD risk factors for both men and women. Upper body fat tends to be more detrimental to cardiometabolic health in women than in men, whereas lower body fat is relatively more protective in men than in women.
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http://dx.doi.org/10.1186/s12889-021-11316-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234731PMC
June 2021

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

Associations Between Single-Child Status and Metabolic Syndrome in Children and Adolescents in China.

Front Pediatr 2021 20;9:661164. Epub 2021 May 20.

Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.

To evaluate the associations between single-child status and metabolic syndrome (MS) and to identify the highest risk group of MS among single children. Differences in participants' characteristics by sex were examined by Student's -test for continuous variables and Pearson's chi-squared test for categorical variables. Multivariate logistic regression analysis was performed to estimate the odds ratios () and 95% confidence intervals () for MS and its components according to the single-child status. Radar maps were used to compare the composition of different components in MS. In total, 11,784 (5,880 boys) children and adolescents were included in this study, with a mean age of (11.3 ± 3.1) years. MS was observed in 7.1% of participants, with a higher prevalence in boys (8.2%) than girls (5.9%) ( < 0.05). The prevalence of MS, elevated blood pressure and abdominal obesity in single children were higher than that in children with siblings, particularly in boys ( < 0.001). Elevated risk of abdominal obesity was observed in single children [boys (1.56, 95% CI: 1.31, 1.85), girls (1.40, 95% CI: 1.19, 1.63)], however, increased ORs of elevated blood pressure and metabolic syndrome were observed in single-child boys only (1.19, 95% CI: 1.01, 1.40 and 1.76, 95% CI: 1.34, 2.31, respectively). Results showed that a statistically significant association between single child status and MS was mainly observed in urban boys (2.04, 95% CI: 1.33, 3.12) and rural boys (1.50, 95% CI: 1.05, 2.15), but not in girls. Among all the combinations of MS, two combinations were significantly associated with the single-child status, including the combination of elevated blood pressure, abdominal and low HDL-C (1.45, 1.04, 2.04) and the combination of elevated blood pressure, abdominal obesity, low HDL-C and hypertriglyceridemia (2.04, 1.40, 3.06) ( < 0.05). The present study found that single children and adolescents had a higher risk of MS, elevated blood pressure and abdominal obesity. The associations were stronger in urban boys. Further attention should be directed to the prevention and control strategies targeting the high-risk population of MS.
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http://dx.doi.org/10.3389/fped.2021.661164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173115PMC
May 2021

Risk Factors for Death Among the First 80 543 COVID-19 Cases in China: Relationships Between Age, Underlying Disease, Case Severity, and Region.

Clin Infect Dis 2021 May 27. Epub 2021 May 27.

Hubei Center for Disease Control and Prevention, 6 North Zuodaoquan, Hongshan District, Wuhan 430079, China.

Background: Knowledge of COVID-19 epidemiology remains incomplete and crucial questions persist. We aimed to examine risk factors for COVID-19 death.

Methods: A total of 80 543 COVID-19 cases reported in China, nationwide, through April 8, 2020 were included. Risk factors for death were investigated by Cox proportional hazards regression and stratified analyses.

Results: Overall national case fatality ratio (CFR) was 5.64%. Risk factors for death were older age (≥80: adjusted hazard ratio [aHR]=12.58, 95% confidence interval [CI]=6.78-23.33), presence of underlying disease (aHR=1.33, CI=1.19-1.49), worse case severity (severe: aHR=3.86, CI=3.15-4.73; critical: aHR=11.34, CI=9.22-13.95), and near-epicenter region (Hubei: aHR=2.64, CI=2.11-3.30; Wuhan: aHR=6.35, CI=5.04-8.00). CFR increased from 0.35% (30-39 years) to 18.21% (≥70 years) without underlying disease. Regardless of age, CFR increased from 2.50% for no underlying disease to 7.72% for 1, 13.99% for 2, and 21.99% for ≥3. CFR increased with worse case severity from 2.80% (mild), to 12.51% (severe) and 48.60% (critical) regardless of region. Compared to other regions, CFR was much higher in Wuhan regardless of case severity (mild: 3.83% versus 0.14% in Hubei and 0.03% elsewhere; moderate: 4.60% versus 0.21% and 0.06%; severe: 15.92% versus 5.84% and 1.86%; and critical: 58.57% versus 49.80% and 18.39%).

Conclusions: Older patients regardless of underlying disease and patients with underlying disease regardless of age were at elevated risk of death. Higher death rates near the outbreak epicenter and during the surge of cases reflect the deleterious effects of allowing health systems to become overwhelmed.
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http://dx.doi.org/10.1093/cid/ciab493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244662PMC
May 2021

ATP2B1 gene polymorphisms rs2681472 and rs17249754 are associated with susceptibility to hypertension and blood pressure levels: A systematic review and meta-analysis.

Medicine (Baltimore) 2021 Apr;100(15):e25530

Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha.

Objective: The present study aimed to conduct a systematic review and meta-analysis to evaluate the relationships between ATP2B1 gene polymorphisms with blood pressure (BP) level and susceptibility to hypertension.

Methods: PubMed, Web of Science, Embase and China National Knowledge Infrastructure (CNKI) Databases were systematically searched by 2 independent researchers to screen studies on ATP2B1 gene polymorphisms and BP related phenotypes. The records retrieval period was limited from the formation of the database to March 4, 2021. Pooled odds rations (ORs) or β and their 95% confidence intervals (95%CI) were calculated to assess the association between ATP2B1 gene polymorphisms and the risk of hypertension or BP levels. Publication bias and sensitivity analysis were conducted to find potential bias. All the statistical analysis were conducted with Stata version 11.0 software.

Results: A total of 15 articles were ultimately included in the present study, including 15 polymorphisms of ATP2B1 gene. Nine articles (N = 65,362) reported the polymorphism rs17249754, and 7 articles(N = 91,997) reported rs2681472 (both loci were reported in 1 article). Meta-analysis showed that rs17249754 (G/A) and rs2681472 (A/G) were associated with the susceptibility to hypertension (rs17249754: OR = 1.19, 95%CI: 1.10-1.28; rs2681472: OR = 1.15, 95%CI: 1.12-1.17), and were positively associated with systolic BP (SBP) and diastolic blood pressure (DBP) (rs17249754: SBP, β=1.01, 95%CI: 0.86-1.16, DBP, β=0.48, 95%CI: 0.30-0.66; rs2681472: SBP, β=0.92, 95%CI: 0.77-1.07, DBP, β=0.50, 95%CI: 0.42-0.58) in the additive genetic model. Subgroup analysis stratified by race, population, sample size, and BP measurement method revealed that the association between A allele in rs2681472 polymorphism and risk of hypertension was slightly stronger in European (EUR) populations (OR = 1.16, 95%CI: 1.13-1.20) than in East Asians (OR = 1.14, 95%CI: 1.10-1.17). While in East Asians, relation between rs17249754 with risk of hypertension (OR = 1.19, 95%CI: 1.10-1.28) is stronger than rs2681472 (OR = 1.14, 95%CI: 1.10-1.17).

Conclusions: Our study demonstrated that ATP2B1 gene polymorphism rs2681472 and rs17249754 were associated with BP levels and the susceptibility to hypertension.
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http://dx.doi.org/10.1097/MD.0000000000025530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052043PMC
April 2021

Ambient air pollution and obesity in school-aged children and adolescents: A multicenter study in China.

Sci Total Environ 2021 Jun 18;771:144583. Epub 2021 Jan 18.

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China. Electronic address:

Background: Environmental factors such as air pollution may contribute to the development of childhood obesity. However, current epidemiological evidence is limited and inconsistent.

Objective: We investigated the associations between long-term air pollution exposure and obesity in a large population of Chinese children and adolescents.

Methods: A total of 44,718 children and adolescents (50.5% boys) aged 7 to 18 years were recruited from seven provinces/municipalities in China. Body mass index (BMI), waist circumference, waist-to-height ratio (WHtR) and the prevalence of general and central obesity were measured. Satellite-based spatial-temporal models were used to estimate ambient concentrations of particulate matter with aerodynamic diameter < 1.0 μm (PM), <2.5 μm (PM), <10.0 μm (PM) and nitrogen dioxide (NO). We used mixed-effects linear and logistic regression models to examine the associations between air pollution exposure and body weight measures.

Results: Exposure to PM, PM, PM and NO was associated with increased BMI Z-score, waist circumference and WHtR, and higher prevalence of both general and central obesity. Generally, stronger associations were observed for particles, especially PM and PM, than for NO. Also, the associations of particles were generally more stable in two-pollutant models. Overall, the associations were more pronounced in boys than in girls except for general obesity.

Conclusions: Long-term exposure to air pollution was associated with increased body weight and higher prevalence of obesity in children and adolescents, suggesting potential obesogenic effects of air pollution.
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http://dx.doi.org/10.1016/j.scitotenv.2020.144583DOI Listing
June 2021

High Color-Purity Red, Green, and Blue-Emissive Core-Shell Upconversion Nanoparticles Using Ternary Near-Infrared Quadrature Excitations.

ACS Appl Mater Interfaces 2021 Jan 12;13(3):4402-4409. Epub 2021 Jan 12.

State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Changchun, Jilin 130012, China.

Development of multicolor-emitting upconversion nanoparticles (UCNPs) is of significant importance for applications in optical encoding, anti-counterfeiting, display, and bioimaging. However, realizing the orthogonal three-primary color (TPC) upconversion luminescence in a single nanoparticle remains a huge challenge. Herein, we have rationally designed core-multishell-structured NaYF UCNPs through regulating the dopant concentration, composition of luminescent layers, and shell position and thickness, which are capable of emitting red, green, and blue luminescence with high color purity in response to ternary near-infrared quadrature excitations (1560/808/980 nm). Moreover, their high color purity is well retained with varying excitation power densities. This orthogonal TPC emissions property of such UCNPs endows them with great promise in the field of security. As a proof-of-concept, we have demonstrated the feasibility of combining such UCNPs with MnO nanosheets for information encryption and decryption. This work not only offers a new way to achieve TPC upconversion luminescence at a single nanoparticle level but also broadens the scope of application for security protection.
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http://dx.doi.org/10.1021/acsami.0c19902DOI Listing
January 2021

Association between birth weight and risk of abdominal obesity in children and adolescents: a school-based epidemiology survey in China.

BMC Public Health 2020 Nov 10;20(1):1686. Epub 2020 Nov 10.

Department of Commissioning, South Western Sydney Primary Health Network, Campbelltown, Australia.

Background: Abdominal obesity is becoming an increasingly serious public health challenge in children and adolescents, there remains controversial opinions on birth weight and risk of childhood abdominal obesity. This study aims to assess the association between birth weight and the risk of abdominal obesity in childhood, as well as to compare the associations among different sex and age groups.

Methods: A total number of 30,486 (15,869 boys and 14,617 girls) participants aged 6-17 years old were included in this study. Participants were classified into five groups according to their birth weight. Waist-to-height ratio (WHtR) was used to define abdominal obesity. Fractional polynomial regression model was used to assess the association between birth weight and WHtR, and a multi-variable logistic regression model was applied to evaluate the risk of abdominal obesity in different birth weight groups.

Results: A J-shaped association was observed between birth weight and WHtR. Compared with birth weight of 2500-2999 g, high birth weight was associated with increased risk of abdominal obesity [OR (95% CI) for 3000-3499 g: 1.12(1.00-1.24); 3500-3999 g: 1.19(1.07-1.34); ≥4000 g: 1.42(1.24-1.62)]. No significant correlation was observed in children with birth weight ≤ 2499 g. Similar patterns were observed across different age groups. Abdominal obesity risk for high birth weight was particularly pronounced in boys compared to girls.

Conclusions: Birth weight ≥ 3000 g, especially for boys, was associated with an elevated risk of abdominal obesity in childhood and may benefit from intervention to mitigate this risk.
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http://dx.doi.org/10.1186/s12889-020-09456-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656713PMC
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

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

Infectious diseases in children and adolescents in China: analysis of national surveillance data from 2008 to 2017.

BMJ 2020 04 2;369:m1043. Epub 2020 Apr 2.

Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Objectives: To outline which infectious diseases in the pre-covid-19 era persist in children and adolescents in China and to describe recent trends and variations by age, sex, season, and province.

Design: National surveillance studies, 2008-17.

Setting: 31 provinces in mainland China.

Participants: 4 959 790 Chinese students aged 6 to 22 years with a diagnosis of any of 44 notifiable infectious diseases. The diseases were categorised into seven groups: quarantinable; vaccine preventable; gastrointestinal and enteroviral; vectorborne; zoonotic; bacterial; and sexually transmitted and bloodborne.

Main Outcome Measures: Diagnosis of, and deaths from, 44 notifiable infectious diseases.

Results: From 2008 to 2017, 44 notifiable infectious diseases were diagnosed in 4 959 790 participants (3 045 905 males, 1 913 885 females) and there were 2532 deaths (1663 males, 869 females). The leading causes of death among infectious diseases shifted from rabies and tuberculosis to HIV/AIDS, particularly in males. Mortality from infectious diseases decreased steadily from 0.21 per 100 000 population in 2008 to 0.07 per 100 000 in 2017. Quarantinable conditions with high mortality have effectively disappeared. The incidence of notifiable infectious diseases in children and adolescents decreased from 280 per 100 000 in 2008 to 162 per 100 000 in 2015, but rose again to 242 per 100 000 in 2017, largely related to mumps and seasonal influenza. Excluding mumps and influenza, the incidence of vaccine preventable diseases fell from 96 per 100 000 in 2008 to 7 per 100 000 in 2017. The incidence of gastrointestinal and enterovirus diseases remained constant, but typhoid, paratyphoid, and dysentery continued to decline. Vectorborne diseases all declined, with a particularly noticeable reduction in malaria. Zoonotic infections remained at low incidence, but there were still unpredictable outbreaks, such as pandemic A/H1N1 2009 influenza. Tuberculosis remained the most common bacterial infection, although cases of scarlet fever doubled between 2008 and 2017. Sexually transmitted diseases and bloodborne infections increased significantly, particularly from 2011 to 2017, among which HIV/AIDS increased fivefold, particularly in males. Difference was noticeable between regions, with children and adolescents in western China continuing to carry a disproportionate burden from infectious diseases.

Conclusions: China's success in infectious disease control in the pre-covid-19 era was notable, with deaths due to infectious diseases in children and adolescents aged 6-22 years becoming rare. Many challenges remain around reducing regional inequalities, scaling-up of vaccination, prevention of further escalation of HIV/AIDS, renewed efforts for persisting diseases, and undertaking early and effective response to highly transmissible seasonal and unpredictable diseases such as that caused by the novel SARS-CoV-2 virus.
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http://dx.doi.org/10.1136/bmj.m1043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114954PMC
April 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

Mariana serpentinite mud volcanism exhumes subducted seamount materials: implications for the origin of life.

Philos Trans A Math Phys Eng Sci 2020 Feb 6;378(2165):20180425. Epub 2020 Jan 6.

Department of Subsurface Geobiological Analysis and Research (D-SUGAR), Japan Agency for Marine-Earth Science and Technology (JAMSTEC), Natsushima-cho, Yokosuka, Kanagawa Prefecture, Japan.

The subduction of seamounts and ridge features at convergent plate boundaries plays an important role in the deformation of the overriding plate and influences geochemical cycling and associated biological processes. Active serpentinization of forearc mantle and serpentinite mud volcanism on the Mariana forearc (between the trench and active volcanic arc) provides windows on subduction processes.  Here, we present (1) the first observation of an extensive exposure of an undeformed Cretaceous seamount currently being subducted at the Mariana Trench inner slope; (2) vertical deformation of the forearc region related to subduction of Pacific Plate seamounts and thickened crust; (3) recovered Ocean Drilling Program and International Ocean Discovery Program cores of serpentinite mudflows that confirm exhumation of various Pacific Plate lithologies, including subducted reef limestone; (4) petrologic, geochemical and paleontological data from the cores that show that Pacific Plate seamount exhumation covers greater spatial and temporal extents; (5) the inference that microbial communities associated with serpentinite mud volcanism may also be exhumed from the subducted plate seafloor and/or seamounts; and (6) the implications for effects of these processes with regard to evolution of life. This article is part of a discussion meeting issue 'Serpentine in the Earth system'.
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http://dx.doi.org/10.1098/rsta.2018.0425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015305PMC
February 2020

Education, Altitude, and Humidity Can Interactively Explain Spatial Discrepancy and Predict Short Stature in 213,795 Chinese School Children.

Front Pediatr 2019 30;7:425. Epub 2019 Oct 30.

State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.

The north-south height distinctions in Chinese children suggest that some geographical-climatic factors could determine height variation of short stature. In a national health survey, we aimed to explore the spatial distribution of short stature on city scales, and detect its socio-economic and geographical-climatic factors. Data on the prevalence of short stature were obtained from a 2014 cross-sectional survey of China (CNSSCH). In total, 213,795 Han Chinese students aged 7-18 years, from 106 cities across 30 provinces, were included. Both China and World Health Organization (WHO) growth references were adopted to define short stature. A spatial clustering was apparent in the distribution of short stature. After multivariable adjustment, altitude and humidity significantly increased the risk of high prevalence in short stature, according to the WHO (odds ratio [OR] = 1.61 and 1.26, 95% confidence interval [CI]: 1.20-2.17 and 1.03-1.54) and China (OR = 1.54 and 1.26; 95% CI: 1.15-2.05 and 1.02-1.55) growth references. Additionally, education significantly decreased the risk of high prevalence in short stature according to the WHO (OR = 0.40; 95% CI: 0.22-0.74) and China (OR = 0.42; 95% CI: 0.22-0.77) growth references. Combining both altitude >400 m and education <9 years, as well as education <9 years and humidity >70%, received the largest effect-size estimate, and significance retained after multivariable adjustment. Our findings indicate that high altitude and humidity increased the risk of high prevalence in short stature, high education was associated with low prevalence. Additionally, we observed possible interactions between education and altitude/humidity. They may interactively explain spatial discrepancy and predict short stature in Chinese school children. Further validations are necessary.
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http://dx.doi.org/10.3389/fped.2019.00425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836719PMC
October 2019

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

Low Birthweight Is Associated with Higher Risk of High Blood Pressure in Chinese Girls: Results from a National Cross-Sectional Study in China.

Int J Environ Res Public Health 2019 08 13;16(16). Epub 2019 Aug 13.

Murdoch Children's Research Institute, Flemington Road, Parkville, Melbourne 3052, Australia.

Objective: To investigate the relationship between low birthweight (LBW) and blood pressure and to assess whether LBW leads to a higher risk of high blood pressure (HBP) by gender in Chinese students aged 6-18 years. Also, to investigate whether the association was affected by childhood obesity.

Methods: Data was obtained from a baseline dataset of a national school-based program. Anthropometric parameters, including height, weight, and blood pressure, were measured, while birthweight and other characteristics were obtained from questionnaires. Stratified chi-squared tests were used to compare the prevalence of HBP between LBW and normal birthweight (NBW) groups in each age and sex category. Multivariable logistic regressions were conducted to estimate the HBP risks in each birthweight group.

Results: Both systolic and diastolic blood pressure showed a U-shaped relationship with increased birthweight. Compared to NBW groups, LBW girls showed a higher HBP risk, with an odds ratio of 1.29 (95% confidence interval (CI): 1.02, 1.64, = 0.033), regardless of their current body mass index status, while no significant association in boys was found. : Low birthweight is associated with higher HBP risk in adolescent girls, regardless of their childhood BMI status.
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http://dx.doi.org/10.3390/ijerph16162898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718998PMC
August 2019

Association of School Residential PM with Childhood High Blood Pressure: Results from an Observational Study in 6 Cities in China.

Int J Environ Res Public Health 2019 07 14;16(14). Epub 2019 Jul 14.

Institute of Child and Adolescent Health & School of Public Health, Peking University Health Science Center, Beijing 100191, China.

Objective: To investigate the association of long-term PM exposure with blood pressure (BP) outcomes in children aged 6-18 years, and to examine the population attributable risk (PAR) of PM exposure.

Methods: A total of 53,289 participants aged 6-18 years with full record of age, sex, BP, height, and local PM exposure from a cross-sectional survey conducted in 6 cities of China in 2013 were involved in the present study. PM data from 18 January 2013 to 31 December 2013 were obtained from the nearest environmental monitoring station for each selected school. Two-level linear and logistic regression models were used to evaluate the influence of PM on children's BP, and PAR was calculated in each sex and age group.

Results: Participants had a mean age of 10.8 (standard deviation: 3.4) years at enrollment, 51.7% of them were boys. U-shaped trends along with increased PM concentration were found for both systolic blood pressure (SBP) and diastolic blood pressure (DBP), with the thresholds of 57.8 and 65.0 μg/m, respectively. Both increased annual mean of PM concentration and ratio of polluted days were associated with increased BP levels and high blood pressure (HBP), with effect estimates for BP ranging from 2.80 (95% CI: -0.51, 6.11) mmHg to 5.78 (95% CI: 2.32, 9.25) mmHg for SBP and from 0.77 (95% CI: -1.98, 3.52) mmHg to 2.66 (-0.35, 5.66) mmHg for DBP, and the odds ratios for HBP from 1.21 (0.43, 3.38) to 1.92 (0.65, 5.67) in the highest vs. the lowest quartiles. Overall, 1.16% of HBP in our participants could be attributed to increased annual mean of PM concentration, while 2.82% could be attributed to increased ratio of polluted days. These proportions increased with age.

Conclusions: The association between long-term PM exposure and BP values appeared to be U-shaped in Chinese children aged 6-18 years, and increased PM exposure was associated with higher risk of HBP.
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http://dx.doi.org/10.3390/ijerph16142515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678215PMC
July 2019

Effect of Overweight and Obesity on High Blood Pressure in Chinese Children and Adolescents.

Obesity (Silver Spring) 2019 09 22;27(9):1503-1512. Epub 2019 Jul 22.

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

Objective: This study aimed to compare the secular trends of high blood pressure (HBP) and the effects of overweight and obesity on HBP between Chinese ethnic minority and Han children and adolescents .

Methods: Data were collected from 224,151 Chinese ethnic minority and 664,094 Han children and adolescents aged 7 to 18 years during three successive, national cross-sectional surveys (2005, 2010, and 2014). Logistic regression and population-attributable risk analyses were used to evaluate the association between HBP and overweight and obesity.

Results: HBP prevalence in ethnic minorities increased from 4.8% in 2005 to 6.3% in 2014, which was significantly higher than the variable HBP trends (4.1% to 5.5%) in Han children and adolescents. Both ethnic minority and Han children and adolescents experienced a rapid increase in overweight and obesity, but the pace of growth for HBP, overweight, and obesity was faster in ethnic minorities than in their Han peers. Moreover, the effects of obesity on HBP in ethnic minorities showed a sustained increase over time but were stable for the Han.

Conclusions: Higher HBP prevalence, faster obesity increases, and a stronger impact of obesity on HBP in children and adolescents of Chinese ethnic minorities predict their looming burden of HBP, which suggests that attention to the cardiovascular disease risks in children and adolescents from ethnic minorities is indicated to reduce their future adult risk.
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http://dx.doi.org/10.1002/oby.22562DOI Listing
September 2019

Particulate matter air pollution and blood glucose in children and adolescents: A cross-sectional study in China.

Sci Total Environ 2019 Nov 12;691:868-873. Epub 2019 Jul 12.

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

Background: The health effects of particulate matter (PM) air pollution on glucose metabolism have been rarely examined in children and adolescents.

Objective: We aimed to investigate the associations between long-term PM exposure and blood glucose and prevalence of impaired fasting glucose in a large population of Chinese children and adolescents.

Methods: In 2013, a total of 11,814 children and adolescents aged 7 to 18 years were recruited from seven provinces/municipalities in China. Fasting blood sample was taken for the measurement of blood glucose. Satellite-based spatial-temporal models were used to estimate exposure to ambient submicrometer particles (PM), fine particles (PM) and thoracic particles (PM). Cross-sectional analyses were performed using mixed-effects multivariable linear and logistic regression models.

Results: After adjustment for a range of covariates, every 10 μg/m increment in PM, PM and PM concentrations was associated with 0.160 [95% confidence interval (CI): 0.039, 0.280], 0.150 (95% CI: 0.044, 0.256) and 0.079 (95% CI: -0.009, 0.167) mmol/L higher blood glucose levels, respectively. PM exposure was also associated with higher prevalence of impaired fasting glucose, but the associations did not reach statistical significance [odds ratio per 10 μg/m increment in PM, PM and PM: 1.30 (95% CI: 0.86,1.96), 1.20 (95% CI: 0.85,1.69) and 1.08 (95% CI: 0.83,1.41)].

Conclusions: We found that long-term exposure to PM air pollution was associated with increased levels of blood glucose in children and adolescents. The associations were more evident for PM and PM.
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http://dx.doi.org/10.1016/j.scitotenv.2019.07.179DOI Listing
November 2019

Spatial and demographic disparities in short stature among school children aged 7-18 years: a nation-wide survey in China, 2014.

BMJ Open 2019 07 16;9(7):e026634. Epub 2019 Jul 16.

Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.

Objectives: To identify spatial disparities and demographic characteristics of short stature, we analysed the prevalence of short stature collected in a nationwide health survey.

Settings: Data were obtained from the 2014 Chinese National Survey on Students Constitution and Health (a cross-sectional study of China). Participants came from 30 provinces, autonomous regions, and municipalities (except Tibet, Hong Kong, Macao, and Taiwan).

Participants: There were 213 795 Han school children between 7 and 18 years old enrolled in our study. All participants were sampled by stratified cluster.

Primary And Secondary Outcome Measures: Short stature; Chinese and WHO age-specific and gender-specific height growth references were used for short stature assessment.

Results: The age-standardised and age-gender-standardised prevalence of short stature nationwide was 3.70% and 2.69% according to Chinese and WHO growth references, respectively. The short stature prevalence differed significantly among age groups, urban and rural areas, and regions with different socioeconomic development levels (all p<0.0001). The prevalence was 2.23% in urban versus 5.12% in rural areas (p<0.001). The prevalence was 2.60% in developed, 3.72% in intermediately developed, and 4.69% in underdeveloped regions (p<0.0001). These values were all according to China's growth reference, but similar patterns were observed on prevalence based on the WHO reference. The spatial distribution of prevalence of short stature presented a clustered pattern. Moran's I value was 0.474 (p0.001) and 0.478 (p0.001) according to the Chinese and WHO growth references, respectively. The southwest part of China showed a higher prevalence of short stature, whereas lower prevalence of short stature was observed mainly in the northeast part of China.

Conclusions: There is an appreciably high prevalence of short stature in rural, underdeveloped areas of China. There are high prevalence spatial clusters of short stature in southwestern China. This provides corroborating evidence for a tailored strategy on short stature prevention and reduction in special areas.
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http://dx.doi.org/10.1136/bmjopen-2018-026634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661596PMC
July 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

[Changes of the nutritional status of children and adolescents aged 7-17 years of Tujia ethnic minority in Hunan Province from 2010 to 2014].

Wei Sheng Yan Jiu 2019 May;48(3):399-402

Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing 100191, China.

Objective: To understand the change of nutritional status of children and adolescents aged 7-17 years from Tujia ethnic minority in Hunan Province, and to provide evidence for the prevention and control policy making of improving the population's nutritional status.

Methods: A total of 4676 children and adolescents aged 7-17 years from Tujia ethnic minority in Hunan Province were included(2310 in year 2010, 2366 in year 2014), sample were recruited in the 2010 and 2014 Chinese National Survey on Students' Constitution and Health. The nutritional status of wasting and stunting was defined by a national malnutrition screening standard(WS/T 456-2014), overweight and obesity were defined by the body mass index percentile criteria developed by Chinese Working Group on Obesity for Children(WGOC).

Results: From 2010 to 2014, the obesity prevalence of Tujia children and adolescents from Hunan increased obviously from 3.1% to 5.7%, and the prevalence of wasting also increased, from 7.8% to 10.5%. The trend analysis of stunting showed that the stunting prevalence decreased significantly from 8.4% in 2010 to 3.5% in 2014.

Conclusion: The stunting issue in Tujia children and adolescents has improved a lot from 2010 to 2014. But the prevalence of stunting is still high, and there is a dual burden of malnutrition and overnutrition.
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May 2019

Association of high birth weight with overweight and obesity in Chinese students aged 6-18 years: a national, cross-sectional study in China.

BMJ Open 2019 05 22;9(5):e024532. Epub 2019 May 22.

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

Background: The prevalence of childhood overweight and obesity in China has drastically increased 57 times over the past 30 years, and to control birth weight is an effective way to reduce the risk of overweight and obesity across the life course.

Objective: This paper aimed to evaluate the association of high birth weight (HBW) with overweight and obesity in Chinese students aged 6-18 years.

Methods: All students with HBW (n=4981) aged 6-18 years were selected from a cross-sectional survey from seven provinces of China, and 4981 other students with normal birth weight (NBW) were randomly sampled with matched gender, age and province. Anthropometric parameters were measured and characteristics were collected by questionnaires. Multiple logistic regression was used to estimate the OR of overweight and obesity with HBW, unadjusted and adjusted for confounding factors.

Results: Participants with HBW revealed higher body mass index in childhood. The prevalence of overweight and obesity was significantly higher in the HBW group than in the NBW group (overweight 15.3% vs 13.1%, p<0.05; obesity 16.9% vs 10.6%, p<0.05), and the results were similar for overweight in all age groups except age 6-7, age 14-15 and age 16-18. Additionally, HBW was positively associated with overweight (OR=1.230; 95% CI 1.056 to 1.432) and obesity (OR=1.611; 95% CI 1.368 to 1.897) after adjustment for covariates.

Conclusions: HBW leads to an increased risk of overweight and obesity in childhood; thus, measures to control birth weight, such as controlling gestational weight gain, should be taken from the earliest beginning of life.

Trial Registration Number: NCT02343588; Post-results.
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http://dx.doi.org/10.1136/bmjopen-2018-024532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538056PMC
May 2019

Exposure to ambient particulate matter air pollution, blood pressure and hypertension in children and adolescents: A national cross-sectional study in China.

Environ Int 2019 07 3;128:103-108. Epub 2019 May 3.

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China. Electronic address:

Background: Air pollution has been associated with elevated blood pressure in adults. However, epidemiological evidence from children and adolescents is limited. We investigated the associations between long-term exposure to particulate matter (PM) air pollution and blood pressure in a large population of children and adolescents.

Methods: A cross-sectional analysis was performed in a nationally representative sample consisting of 43,745 children and adolescents aged 7 to 18 years in seven provinces in China. Exposure to ambient fine particles (PM) and thoracic particles (PM) was estimated using spatiotemporal models based on satellite remote sensing, meteorological data and land use information. Mixed-effects (two-level) linear and logistic regression models were used to investigate the associations between PM exposure and systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension.

Results: After adjustment for a wide range of covariates, every 10 μg/m increment in PM and PM concentration was associated with 1.46 [95% confidence interval (CI): 0.05, 2.88] and 1.36 (95% CI: 0.34, 2.39) mmHg increases in SBP, respectively. PM was also associated with higher prevalence of hypertension [odds ratio per 10 μg/m increment: 1.45 (95% CI: 1.07, 1.95)].

Conclusions: Long-term exposure to ambient PM air pollution was associated with increased blood pressure and higher prevalence of hypertension in children and adolescents. Our findings support air pollution reduction strategies as a prevention measure of childhood hypertension, a well-recognized risk factor of future cardiovascular health.
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http://dx.doi.org/10.1016/j.envint.2019.04.036DOI Listing
July 2019

Parental smoking and blood pressure in children and adolescents: a national cross-sectional study in China.

BMC Pediatr 2019 04 18;19(1):116. Epub 2019 Apr 18.

Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China.

Background: Current evidence on the health effects of passive smoking on childhood blood pressure is limited and inconsistent. We investigated the associations between exposure to parental smoking and blood pressure in children and adolescents.

Methods: A cross-sectional analysis was performed in a national sample of 42,745 children and adolescents (50.2% boys) aged 7-18 years from seven provinces in China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Information on parental smoking was collected through questionnaire. Multivariable linear regression and logistic regression was used to investigate the associations of parental smoking with blood pressure and prevalent hypertension, respectively.

Results: The reported parental smoking rates were 49.7 and 50.2% in boys and girls, respectively. After adjustment for a range of potential confounders, exposure to parental smoking was associated with 0.44 [95% confidence interval (CI): 0.16, 0.72] mmHg and 0.26 (95% CI: 0.04, 0.47) mmHg higher SBP and DBP in girls. Girls exposed to parental smoking were also more likely to have hypertension compared with those without exposure (odds ratio = 1.11, 95% CI: 1.02, 1.20). No significant associations were found in boys.

Conclusions: Exposure to parental smoking was associated with increased blood pressure and higher prevalence of hypertension in girls, but not in boys. Urgent strategies are needed for the promotion of smoking-free environment, especially for children and adolescents.
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http://dx.doi.org/10.1186/s12887-019-1505-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474055PMC
April 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

Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: an analysis of five successive national surveys.

Lancet Diabetes Endocrinol 2019 04;7(4):288-299

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

Background: Socioeconomic development is widely regarded as contributing to improved nutrition in children. We aimed to assess the association between socioeconomic indicators and child and adolescent nutritional status, and the differences in this association between urban and rural areas.

Methods: We extracted data from the 1995, 2000, 2005, 2010, and 2014 cycles of the Chinese National Survey on Students' Constitution and Health. We analysed these data for three nutritional outcomes-stunting, thinness, and overweight and obesity-in children and adolescents aged between 7 and 18 years, as defined by WHO standards and classifications. We included three socioeconomic indicators-gross domestic product (GDP) per capita, Engel coefficient (the proportion of household income spent on food), and urbanisation ratio-at both national and subnational levels for each survey year. We used logistic regression models to estimate the association between socioeconomic indicators and child nutritional status, and used prevalence odds ratios (ORs) to assess the urban-rural disparity for nutritional status over time. We also used generalised additive models to evaluate differences in associations between socioeconomic and nutritional status between urban and rural areas.

Findings: We included 1 054 602 participants (204 932 in 1995; 209 167 in 2000; 225 213 in 2005; 208 136 in 2010; 207 154 in 2014) with complete records on age, sex, nationality, height, and weight in the final analyses, and the final dataset contained 29 provinces (Hong Kong, Macau, Taiwan, Chongqing, and Tibet were excluded) with complete socioeconomic indicator information and student nutritional status information. From 1995 to 2014, the mean stunting prevalence in Chinese children and adolescents decreased from 8·1% (95% CI 8·0-8·2) to 2·4% (2·4-2·5), and the mean thinness prevalence declined from 7·5% (7·4-7·6) to 4·1% (4·0-4·2). Overweight and obesity mean prevalence increased from 5·3% (5·2-5·4) to 20·5% (20·4-20·7). We observed an inverse association between socioeconomic indicators and mean stunting and thinness prevalence, and found a positive association between socioeconomic indicators and overweight and obesity prevalence. The urban-rural disparity in nutritional status gradually diminished, with the prevalence ORs approaching equivalence over time. More rapid improvement of socioeconomic indicators was associated with changed nutritional status in children and adolescents, but with differences across urban and rural settings. The association between socioeconomic status and overweight and obesity was stronger in rural than in urban areas. Improvements (reductions) in the Engel coefficient were accompanied by a greater reduction of stunting and thinness in rural than in urban areas.

Interpretation: Although socioeconomic development has been accompanied by continued improvements in stunting and thinness, a marked increase has occurred in overweight and obesity in Chinese children and adolescents, particularly in rural areas. There is a pressing need for policy actions to extend beyond an emphasis on economic growth alone, and to focus on promotion of healthy diets and physical activity.

Funding: National Natural Science Foundation, The Research Special Fund for Public Welfare Industry of Health of the Ministry of Health of China, and China Scholarship Council.
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http://dx.doi.org/10.1016/S2213-8587(19)30075-0DOI Listing
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
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