The objective of this study was to develop a Chinese Healthy Eating Index (CHEI) based on the updated Dietary Guidelines for Chinese (DGC-2016) and to apply it in the 2011 China Health and Nutrition Survey (CHNS-2011) to assess diet quality and its association with typical sociodemographic/economic factors. Data from 14,584 participants (≥2 years) from the CHNS-2011, including three 24-h dietary recalls and additional variables, were used to develop the CHEI. The standard portion size was applied to quantify food consumption. The CHEI was designed as a continuous scoring system, comprising 17 components; the maximum total score is 100. The mean, 1st and 99th percentiles of the CHEI score were 52.4, 27.6 and 78.3, respectively. Young and middle-aged adults scored better than the elderly. Diet insufficiency was chiefly manifested in fruits, dairy, whole grains and poultry; diet excess was mainly reflected in red meat, cooking oils and sodium. The CHEI was positively associated with education and urbanization levels; current smokers and unmarried people obtained relative low CHEI scores. Occupation and body mass index (BMI) were also related to the CHEI. Our findings indicate that the CHEI is capable of recognizing differences in diet quality among the Chinese, and it is sensitive to typical sociodemographic/economic factors.

Dietary patterns are linked to obesity, but the gender difference in the association between dietary patterns and obesity remains unclear. We explored this gender difference in a middle-aged and elderly populations in Shanghai. Residents (n = 2046; aged ≥45 years; 968 men and 1078 women) who participated in the Shanghai Food Consumption Survey were studied. Factor analysis of data from four periods of 24-h dietary recalls (across 2012–2014) identified dietary patterns. Height, body weight, and waist circumference were measured to calculate the body mass index. A log binominal model examined the association between dietary patterns and obesity, stratified by gender. Four dietary patterns were identified for both genders: rice staple, wheat staple, snacks, and prudent patterns. The rice staple pattern was associated positively with abdominal obesity in men (prevalence ratio (PR) = 1.358; 95% confidence interval (CI) 1.132–1.639; p = 0.001), but was associated negatively with general obesity in women (PR = 0.745; 95% CI: 0.673–0.807; p = 0.031). Men in the highest quartile of the wheat staple pattern had significantly greater risk of central obesity (PR = 1.331; 95% CI: 1.094–1.627; p = 0.005). There may be gender differences in the association between dietary patterns and obesity in middle-aged and elderly populations in Shanghai, China.

The Chinese Healthy Eating Index (CHEI) is a measuring instrument of diet quality in accordance with the Dietary Guidelines for Chinese (DGC)-2016. The objective of the study was to evaluate the validity and reliability of the CHEI. Data from 12,473 adults from the China Health and Nutrition Survey (CHNS)-2011, including 3-day–24-h dietary recalls were used in this study. The CHEI was assessed by four exemplary menus developed by the DGC-2016, the general linear models, the independent t-test and the Mann–Whitney U-test, the Spearman’s correlation analysis, the principal components analysis (PCA), the Cronbach’s coefficient, and the Pearson correlation with nutrient intakes. A higher CHEI score was linked with lower exposure to known risk factors of Chinese diets. The CHEI scored nearly perfect for exemplary menus for adult men (99.8), adult women (99.7), and the healthy elderly (99.1), but not for young children (91.2). The CHEI was able to distinguish the difference in diet quality between smokers and non-smokers (P < 0.0001), people with higher and lower education levels (P < 0.0001), and people living in urban and rural areas (P < 0.0001). Low correlations with energy intake for the CHEI total and component scores (|r| < 0.34, P < 0.01) supported the index assessed diet quality independently of diet quantity. The PCA indicated that underlying multiple dimensions compose the CHEI, and Cronbach’s coefficient α was 0.22. Components of dairy, fruits and cooking oils had the greatest impact on the total score. People with a higher CHEI score had not only a higher absolute intake of nutrients (P < 0.001), but also a more nutrient-dense diet (P < 0.001). Our findings support the validity and reliability of the CHEI when using the 3-day–24-h recalls.

Background Poor olfaction is associated with worse functional performance in older adults, but longitudinal evidence is lacking. We investigated poor olfaction in relation to longitudinal changes in physical functioning among community-dwelling older adults. Methods The analysis included 2,319 participants from the Health, Aging and Body Composition Study (aged 71-82 years, 47·9% men, and 37·3% blacks) who completed the Brief Smell Identification Test in 1999-2000. Olfaction was defined as good (test score 11-12), moderate (9-10), or poor (0-8). Physical functioning was assessed up to four times over 8 years, using the Short Physical Performance Battery (SPPB) and the Health ABC Physical Performance Battery (HABCPPB). We conducted joint model analyses and reported the differences in annual declines across olfaction groups. Results During the follow-up, compared to those with good olfaction, older adults with poor olfaction had greater annual declines in both the SPPB score (-0.137, 95%CI: -0.186, -0.088) and all its subscales: standing balance (-0.068, 95%CI:-0.091, -0.044), chair stand (-0.046, 95%CI: -0.070, -0.022), and gait speed (-0.022, 95%CI: -0.042, -0.001). A similar observation was made for the HABCPPB score (difference in annual decline: -0.032, 95%CI:-0.042, -0.021). These findings are robust and cannot be explained by measured confounding from demographics, lifestyle factors, chronic diseases, nor by potential biases due to death and loss of follow-up. Similar associations were observed across subgroups of sex, race, and self-reported general health status. Conclusion This study provides the first epidemiological evidence that poor olfaction predicts a faster decline in physical functioning. Future studies should investigate potential mechanisms.

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