China’s food consumption patterns and eating and cooking behaviors changed dramatically between 1991 and 2011. Macronutrient composition has shifted toward fats, and protein and sodium intakes remain high and potassium intake low. The rapid decline in intake of coarse grains and, later, of refined grains and increases in intake of edible oils and animal-source foods accompanied by major eating and cooking behavior shifts are leading to what might be characterized as an unhealthy Western type of diet, often based on traditional recipes with major additions and changes. The most popular animal-source food is pork, and consumption of poultry and eggs is increasing. The changes in cooking and eating styles include a decrease in the proportion of food steamed, baked, or boiled and an increase in snacking and eating away from home. Prior to the last decade there was essentially no snacking in China except for hot water or green tea. Most recently the intake of foods high in added sugar has increased. The dietary shifts are affected great by the country’s urbanization. The future, as exemplified by the diet of the 3 mega cities, promises major growth in consumption of processed foods and beverages.

Background The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment (MCI) in population-based epidemiologic studies. However, their comparison on which is best suited to assess cognition is scarce in samples from multiple regions of China. Methods We conducted a cross-sectional analysis of 4923 adults aged ≥55 years from the Community-based Cohort Study on Nervous System Diseases. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Education-specific cutoffs of total score were used to diagnose MCI. Demographic and health-related characteristics were collected by questionnaires. Correlation and agreement for MCI between MMSE and MoCA were analyzed; group differences in cognition were evaluated; and multiple logistic regression model was used to clarify risk factors for MCI. Results The overall MCI prevalence was 28.6% for MMSE and 36.2% for MoCA. MMSE had good correlation with MoCA (Spearman correlation coefficient = 0.8374, p < 0.0001) and moderate agreement for detecting MCI with Kappa value of 0.5973 (p < 0.0001). Ceiling effect for MCI was less frequent using MoCA versus MMSE according to the distribution of total score. Percentage of relative standard deviation, the measure of inter-individual variance, for MoCA (26.9%) was greater than for MMSE (19.0%) overall (p < 0.0001). Increasing age (MMSE: OR = 2.073 for ≥75 years; MoCA: OR = 1.869 for≥75 years), female (OR = 1.280 for MMSE; OR = 1.163 for MoCA), living in county town (OR = 1.386 and 1.862 for MMSE and MoCA, respectively) or village (OR = 2.579 and 2.721 for MMSE and MoCA, respectively), smoking (OR = 1.373 and 1.288 for MMSE and MoCA, respectively), hypertension (MMSE: OR = 1.278; MoCA: OR = 1.208) and depression (MMSE: OR = 1.465; MoCA: OR = 1.350) were independently associated with greater likelihood of MCI compared to corresponding reference group in both scales (all p < 0.05). Conclusions MoCA is a better measure of cognitive function due to lack of ceiling effect and with good detection of cognitive heterogeneity. MCI prevalence is higher using MoCA compared to MMSE. Both tools identify concordantly modifiable factors for MCI, which provide important evidence for establishing intervention measures.

Dietary patterns represent the combined effects of foods, and illustrate efficaciously the impact of diet on health outcomes. Some findings of previous studies have limited applicability to Chinese children due to cultural factors. The presnt study was designed to identify dietary patterns and determine their relationships with obesity among Chinese children and adolescents. Data collected from 1282 children and adolescents aged 7–17 years from the 2011 China Health and Nutrition Survey (CHNS) were used. Dietary patterns were identified using factor analysis of data from three consecutive 24-h dietary recalls. Weight and height were measured following standard methods, and BMI was calculated. Three dietary patterns were identified: modern (high intakes of milk, fast foods and eggs), traditional north (high intakes of wheat, tubers and other cereals) and traditional south (high intakes of vegetables, rice and pork). After adjusting for some confounders and total energy intake, subjects in the highest quartiles of the modern and traditional north patterns were found to have significantly greater risk of obesity (OR 3·10, 95 % CI 1·52, 6·32, and OR 2·42, 95 % CI 1·34, 4·39, respectively). In conclusion, the modern dietary pattern and the traditional north dietary pattern were associated with higher risk of obesity. Promoting healthier eating patterns could help prevent obesity in Chinese children.

Background: The Perceived Stress Scale (PSS) is a globally used and self-report scale measuring perceived stress. Three versions of PSS (PSS-14, PSS-10 and PSS-4) are available which comprise 14, 10 and 4 items respectively. However, the Chinese version of the PSS has not yet been validated in a large community-based general population. The aims of this study were to evaluate the psychometric properties of the Chinese PSS in a large community-based general population and to compare the appropriateness of the three versions of PSS. Methods: A total of 9507 adults with at least a junior high school education and completed PSS-14 from the China Health and Nutrition Survey were involved in this study. The internal consistency reliability of PSS was assessed using Cronbach's alpha coefficient and confirmatory factor analysis was employed to test the construct validity. Modification index was used for model extension and the critical ratio was used for model restriction. Results: The internal consistency coefficients were satisfactory for PSS-14 and PSS-10, but not for PSS-4. The corresponding Cronbach's alpha were 0.830, 0.754 and 0.473 respectively. A 2-factor structure was confirmed for the PSS-14 and PSS-10, and all items' standardized factor loadings exceeded 0.4 for either negative or positive factors. Given that item 12 loaded on both negative and positive factors for PSS-14 and the goodness of fit for PSS-14 was not acceptable, PSS-13 (PSS-14 excluding item 12) was studied. The construct validities of PSS-13 and PSS-10 were satisfactory, but the goodness of fit for PSS-10 were better than that for PSS-13. Conclusions: PSS-13 (PSS-14 excluding item 12) and PSS-10 have satisfactory psychometric properties. PSS-10 are more applicable to measure the perceived stress than PSS-13 in a large community-based general population in China.

BackgroundThe prevalence of childhood overweight and obesity in developed countries appears to be plateauing. The purpose of this study was to provide the most recent data on the prevalence and trends in overweight and obesity among Chinese children and adolescents from 2011 to 2015.MethodsWe used data collected in the China Health and Nutrition Survey (CHNS) and China Nutritional Transition Cohort Study (CNTCS). We used two waves of the survey in 12 provinces conducted in 2011 (aged 7–18 years; n = 1458) and 2015 (aged 7–18 years; n = 1084) to perform a trend analysis. We used data collected in 15 provinces (aged 7–18 years; n = 1617) to estimate the prevalence of overweight and obesity among Chinese children and adolescents in 2015.ResultsIn 2015, based on the Working Group for Obesity in China (WGOC) criteria, the prevalence of overweight and obesity were 14.0% (95% CI, 11.6–16.3) and 10.5% (95% CI, 8.4–12.6) in boys, and 9.7% (95% CI, 7.7–11.8) and 7.1% (95% CI, 5.2–8.9) in girls, respectively. The increase in BMI z-scores from 2011 to 2015 was statistically significant among adolescents (p = 0.0083), but not among children. No significant changes were observed in prevalence of overweight and obesity between 2011 and 2015, excepting adolescents aged 12–18 years (p = 0.0086).ConclusionsSince 2011, overweight has remained stable, and obesity has stabilized in children, though not in adolescents. Although levels of childhood overweight and obesity in China are not high compared to other developed countries, they remain concerning enough that effective policies and interventions need to be sustained and intensified for lowering rates of childhood overweight and obesity.

Poor dietary habits have been shown to be associated with a range of chronic diseases and can potentially be a major contributor to non-communicable diseases (NCDs) mortality. We therefore aimed to identify the prevailing dietary patterns among Chinese adults and to evaluate trends in dietary patterns from 1991 to 2015. We used data collected in the China Health and Nutrition Survey (CHNS). Dietary patterns were identified using factor analysis of data from three consecutive 24 h dietary recalls. We studied 29,238 adults aged 18 and above with complete demo-graphic and dietary data. Three distinct dietary patterns were identified: southern (high intakes of rice, vegetables, and pork), modern (high intakes of fruits, dairy products, cakes, cookies, and pastries), and meat (high intakes of organ meats, poultry, and other livestock meat). The southern pattern score decreased (mean ± SD scores in 1991: 0.11 ± 1.13; scores in 2015: −0.22 ± 0.93). The modern pattern score (mean ± SD scores in 1991: −0.44 ± 0.59; scores in 2015: 0.21 ± 1.01) and meat pattern score (mean ± SD scores in 1991: −0.18 ± 0.98; scores in 2015: 0.27 ± 0.91) increased. We observed that China has experienced a shift from traditional dietary patterns to western dietary patterns.

The traditional south pattern of rice as the major staple food with pork and vegetable dishes is associated with lower risk of general and abdominal obesity. The traditional north pattern of high intake of wheat, other cereals and tubers is positively associated with general and abdominal obesity. This provides important information for interventions and policies addressing obesity prevention among young Chinese women.

ObjectivesThe neighbourhood availability of restaurants has been linked to the weight status. However, little is known regarding the relation between access to restaurant and obesity among the Chinese population. This study aims to explore the relationship between neighbourhood restaurant density and body mass index (BMI) in rural China.DesignA longitudinal study using data from the China Health and Nutrition Survey (CHNS) was conducted. Participants aged 18 and older from the 2004, 2006, 2009 and 2011 CHNS were recruited Separate sex-stratified random intercept-slope growth models of repeated BMI observations were estimated in the study.SettingThe data were derived from rural communities in nine provinces in China.ParticipantsThere were 11 835 male and 12 561 female person-years assessed in this study.OutcomesThe primary outcome of this study was weight status. It is defined as a BMI value, a continuous variable which is calculated by dividing weight (kg) by the square of height (m2).ResultsThe study indicated that among men an increase of one indoor restaurant in the neighbourhood was associated with a 0.01 kg/m2 increase in BMI, and an increase of one fixed outdoor food stall was associated with a 0.01 kg/m2 decrease in BMI, whereas among women, an increase of one indoor restaurant in the neighbourhood was associated with a 0.005 kg/m2 increase in BMI, and an increase of one fast-food restaurant and one fixed outdoor food stall was associated with a 0.02 and 0.004 kg/m2 decline in BMI, respectively.ConclusionsThe density of neighbourhood restaurants was found to be significantly related to BMI in rural China. The results indicated that providing healthy food choices and developing related public health policies are necessary to tackle obesity among rural Chinese adults.