Background: Pediatric overweight and obesity has become a major public health problem in China. The goal of this study is to understand overweight and obesity in preschool children in Changsha City in the context of their sleep and physical activity. These results offer feasible proposals to reduce levels of overweight and obesity among preschool children. Methods: A total of 112 preschoolers aged three to six years old were investigated using multiple stage stratified cluster sampling and simple random sampling. Questionnaires were used to collect general information about children and their families. Body mass index (BMI) was used as an indicator of overweight and obesity. Age- and sex-specific cutoff values for Chinese children and adolescents were used to determine child weight status. Children’s sedentary time was reported by caregivers, while physical activity and sleep were recorded using fitness bracelets (Misfit Shine 2). Results: The prevalence of childhood overweight and obesity were 15.2% and 9.8% respectively. Preschool-aged children travelled 11,111 ± 3357 and 10,350 ± 2973 steps per day on weekdays and weekends respectively. The number of daily steps was not statistically different between weekdays and weekends. The amount of time spent daily doing vigorous activity on weekdays and weekends was significantly different, with an average time of 20.5 ± 31.6 min and 10.3 ± 15.3 min respectively (p = 0.002). Furthermore, 10.7% and 50.9% of children used screens for more than two hours on weekdays and weekends respectively (p < 0.001). Children slept for significantly longer on weekends (8.3 ± 0.9 h) than on weekdays (8.1 ± 0.7 h) (p = 0.037). A significantly higher proportion of students also fell asleep before 10:00 p.m. on weekends (26.8%) compared to weekdays (15.2%) (p < 0.001). Parent’s BMI values were positively correlated with child BMI, the monthly household income was negatively associated with child BMI. Male children were more likely to have a higher BMI than female children. Children who were obese were also more likely to have shorter sleep times compared to children of normal weight (p = 0.047). Conclusions: There was a high prevalence of overweight and obesity among the Chinese preschool children in this study. Students also demonstrated poor sleep and physical activity habits. Future research is necessary to explore the relationship between sleep, physical activity and weight status for young children in China.

Left-behind children (LBC) are a unique population in China, whose numbers have increased dramatically in recent years. Most caregivers of left-behind children (CLBC) are grandparents who lack knowledge about proper nutrition and food practice, putting LBC at greater risk for malnutrition. A cluster randomized controlled trial was carried to assess the effectiveness of the conditional cash transfer (CCT) program. Forty rural villages from Fenghuang County and Pingjiang County of Hunan province were selected. The villages were randomized into the intervention and control groups. In the intervention group, caregivers received a cash transfer conditional on bimonthly health education attendance, bringing LBC in for vaccinations, and on-time annual health checks. The control group received routine health services only. Two rounds of questionnaire surveys were conducted in March 2015 and July 2016. Questionnaires and in-person interviews were used to assess the changes in nutritional knowledge and food practices among CLBC. Among 447 valid subjects, CLBC in the intervention group were significantly more likely to correctly understand the importance of children’s height and weight measurements, food variety, inclusion of eggs and dairy in the diet, and anemia identification and prevention. Intervention group CLBC were also significantly more likely to prepare dairy products and eggs for their children. Generalized liner mixed model (GLMM) analysis showed that CLBC nutrition knowledge was improved significantly in the intervention group (adjusted p value = 0.01), and there were also positive changes in their food practice (adjusted p value = 0.047). This CCT intervention turned to be effective with respect to rural caregivers’ nutritional knowledge and food practice behavior. The findings from this project could be helpful for future health strategies targeting rural children, in particular the LBC group.

Introduction: Early childhood obesity in China has become a pressing public health concern. A substantial barrier to healthy weight management is poor parental recognition of child overweight. This study examined the relationship between caregiver perceptions of child weight and dietary practices. Methods: A total of 364 children between 2 and 6 years old from six urban preschools in Changsha (China) were included in a cross-sectional study. Information on household demographics, health behaviors, and caregiver attitudes was collected through a self-administered caregiver questionnaire. Chi-squared tests, t-tests, and multivariable logistic regression analysis were used to determine the relationship between caregiver perceptions, dietary behaviors, and child weight status. Results: Over 60% of caregivers with overweight/obese children underestimated their children’s weight status. These caregivers were less likely to worry about weight and restrict their children’s dietary intakes. Children of caregivers who incorrectly classified their weights were also more likely to have a poor appetite. Caregivers of male children and those from families with incomes between 7000 and 11,000 Ren Min Bi (RMB) were more likely to underestimate weight compared to caregivers with daughters and those from higher income households. Conclusions: Although accurate weight perception may be important for motivating healthy behavioral changes, it may also lead to greater restriction of children’s diets, which has been linked to long-term weight gain. Interventions to improve awareness of child overweight should be coupled with efforts that teach caregivers about healthy weight management strategies.

Left-behind children (LBC) are a newly emerged social group in China. Poor nutritional status is particularly prominent in this population. However, their food insecurity tends to attract very little attention. This study aims to investigate the relationship between food insecurity and undernutrition (stunting and anaemia) in 3 to 5-year-old LBC in rural China. Face-to-face interviews were administered to 553 LBC caregivers in 40 rural villages of Hunan Province, China. The Household Food Insecurity Access Scale (HFIAS) was used to assess household food insecurity (HFI). Dietary diversity score (DDS) and food group consumption frequency were measured by 24 h-recall and food frequency questionnaires (FFQ). Hemoglobin tests and anthropometric measurements including height and weight were measured by trained health professionals. Logistic regression was constructed to assess the association between household food insecurity and dietary diversity, stunting, and anaemia. A high prevalence of household food insecurity was determined (67.6%). The weighted prevalence of stunting and anaemia were 16.6% and 26.5%, respectively. Food insecurity was positively associate with LBC stunting (severe HFI: OR = 6.50, 95% CI: 2.81, 15.00; moderate HFI: OR = 3.47, 95% CI: 1.60, 7.54), and anaemia (severe HFI: OR = 1.91, 95% CI: 1.02, 3.57). LBC with food insecurity had significantly lower dietary diversity than those who were food-secure (p < 0.001). The prevalence of household food insecurity among LBC in poor rural China is high and is associated with low DDS, stunting, and anaemia. Nutritional intervention programs and policies are urgently needed to reduce household food insecurity and undernutrition for this vulnerable population.

Background: The caregivers of left-behind children (CLBC) in China’s poor, rural areas are mostly elderly and women. Their health status and access to health services have not been previously characterized. This study aims to explore the status of CLBC in terms of their health service utilization and to provide a scientific basis for guiding effective implementation of health policy in rural Hunan. Methods: Random cluster sampling was used to survey CLBC in two rural counties. Face-to-face interviews and questionnaires were used to collect data, including socioeconomic status and health service utilization. The two-week prevalence rate was used to reflect health service needs, while the two-week visiting rate, annual hospitalization rate and participation in basic public health services were used to evaluate health service utilization. Results: Of the 518 respondents in the study, 95.9% were farmers and 88.4% were over 40 years old. The two-week prevalence rate was 36.1%. Furthermore, 40.1% of ill caregivers’ activities were partly restricted by illness and 3.7% needed to be on bed rest. The two-week visiting rate was 21.0%. The main reasons for not seeing a doctor were “self-medication” (39.1%) or “financial difficulties” (32.6%). The annual hospitalization rate of the CLBC was 22.6% and the non-hospitalization rate of those who needed hospitalization was 41.5%. “Lack of time” (22.3%) and “financial difficulties” (50.5%) were the major factors affecting the utilization of hospitalization services. In terms of participation in basic public health services, only 35.1% CLBC clearly knew that township hospitals have established health records for them. Only 50.6% of caregivers received free health examinations in village clinics or township hospitals and 81.3% of the caregivers did not participate in health education or lectures organized by local health institutions in 2014. Conclusions: The utilization rate of health services was extremely low, which may affect the quality of care for left-behind children. Better public health education through multi-sector cooperation is urgently needed to improve health cognition among CLBC in rural China.