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CN 34-1304/R ISSN 1674-3679

2021 Vol. 25, No. 5

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Literature Review
Comparing the diet change in 30 years of reform and opening up, and promoting the development of nutrition improvement of school-age children
ZHANG Qian, ZHAO Wen-hua
2021, 25(5): 497-499. doi: 10.16462/j.cnki.zhjbkz.2021.05.001
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Abstract:
Six to seventeen years old is the key period for children's growth and development. Adequate and suitable dietary intake would supply the material basis to ensure their health. Moreover, the healthy eating habits cultivated in this period would also benefit their whole life. The reform and opening up between 1982 and 2012 has brought about rapid economic and social development, which has changed the lifestyle of Chinese people. It is of great scientific value and social importance to analyze the changes of diet and nutrition status of Chinese school-age children during this period, for formulating relevant policies to improve children's healthy growth in China.
Strengthen the research on children's health and nutrition and promote the prevention and control of childhood obesity
ZHANG Wen-ting, LIU Dan, MAO Chen, YANG Xing-fen
2021, 25(5): 500-503. doi: 10.16462/j.cnki.zhjbkz.2021.05.002
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The global prevalence of childhood and adolescent obesity has greatly increased in past three decades, and it has spread in both developed and developing countries. Overweight or obesity in childhood may increase the risk of cardiovascular disease, insulin resistance, musculoskeletal diseases and premature death; secondly, overweight and obesity may also lead to a series of mental, psychological and psychosocial disorders in children, including depression, anxiety, inferiority, a range of emotional and behavioral disorders. The number of obese children and adolescents in China ranks first in the world, which is related to excessive intake of sugary drinks, unreasonable dietary structure and reduced amount of exercise.
Nutrition and Health Surveillance
Comparative analysis of dietary cooking oil intake of Chinese children aged 6-17 years in 1982 and 2012
WANG Hong-liang, XU Pei-pei, CAO Wei, GAN Qian, XU Juan, WANG Lu-lu, YANG Ti-ti, LI Li, PAN Hui, HU Xiao-qi, HE Yu-na, WANG Yu-ying, ZHANG Qian, ZHAO Wen-hua
2021, 25(5): 504-508. doi: 10.16462/j.cnki.zhjbkz.2021.05.003
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  Objective  To analyze the status and changes of dietary cooking oil intake in Chinese children aged 6-17 years (hereinafter called school-age children) in 1982 and 2012.  Methods  The data were from 1982 National Nutrition Survey and 2010-2012 China National Nutrition and Health Survey. School-age children were included in this study. The intake of cooking oil for household was recorded by the method of weighing and accounting. The average of condiments intake of school-age children was calculated by the proportion of the children's standard eating days in the total family standard eating days.  Results  The cooking oil intakes of school-age children were 7.22 g/d and 31.67 g/d in 1982 and 2012, respectively. In 1982, the intakes of vegetable oil and animal oil for school-age children were 4.87 g/d and 2.35 g/d, respectively. In 2012, the intakes of vegetable oil and animal oil for school-age children were 28.10 g/d and 3.57 g/d, respectively. In comparison with the data of 1982, the intake of cooking oil increased by 24.45 g/d in 2012. In 1982, 4.31% of school-age children consumed more than 30 g of cooking oil. In 2012, 37.81% of school-age children consumed more than 30 g of cooking oil.  Conclusions  From 1982 to 2012, the intake of dietary cooking oil of school-age children showed an increasing trend. In 2012, the intake level of cooking oil was high and nearly 40% of school-age children consumed more than 30 g of cooking oil. It is recommended that the action of "reduced salt, reduced oil, reduced sugar, healthy oral cavity, healthy weight, healthy bone" pays more attention to children and comprehensive measures should be taken to reduce the usage amount of cooking oil in children.
Changes of the dietary intake of vegetable and fruit among Chinese children aged 6-17 in 1982 and 2012
XU Juan, WANG Lu-lu, YANG Ti-ti, XU Pei-pei, LI Li, CAO Wei, GAN Qian, PAN Hui, WANG Hong-liang, HU Xiao-qi, HE Yu-na, SI Xiang, ZHAO Wen-hua, ZHANG Qian
2021, 25(5): 509-514. doi: 10.16462/j.cnki.zhjbkz.2021.05.004
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  Objective  To analyze the change characteristics of fruits and vegetables intake among Chinese children aged 6-17 years in 1982 and 2012.  Methods  18 237 and 5 819 children aged 6-17 years old from the 1982 China Nutrition Survey and China Nutrition and Health Surveillance (2010-2012) were recruited respectively. Three consecutive 24-hour recalls method and weight records method were used to collect the food intake among children. The intakes of vegetables and fruits of children and the proportion reaching WHO recommended intake were analyzed and compared in the two years.  Results  From 1982 to 2012, Children' s vegetable intake dropped from 300.4 g to 185.8 g (Z=45.9, P < 0.001); the fruit intake of children increased from 28.2 g to 45.9 g (Z=36.8, P < 0.001), the proportion of children reaching 80% of the WHO recommended amount of total intake of fruits and vegetables decreased from 42.2% to 21.6% (χ2 =809.9, P < 0.001). In each year, boys' vegetable intake was higher than girls', and children's vegetable intake gradually increased with ages, fruit intake of urban children was higher than that of rural children.  Conclusions  Compared with 1982, the vegetable intake of Chinese children aged 6 to 17 years decreased significantly, and the intake of fruits increased in 2012. The intake of vegetables and fruits of children was insufficient in each year. Comprehensive intervention should be urgently needed to effectively promote fruit and vegetable consumption of children.
Study on the association between macronutrients intake and abdominal obesity in Chinese children and adolescents aged 7-17 years
LIANG Fen, NAN Ying, SONG Wei-qi, WANG Jin-dong, SUN Yu, ZHANG Wen-ting, LIU Dan, MAO Chen
2021, 25(5): 515-520, 546. doi: 10.16462/j.cnki.zhjbkz.2021.05.005
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  Objective  To explore the effect of macronutrient energy supply ratios on precentral obesity/central obesity in children and adolescents.  Methods  A cross-sectional study was conducted on children and adolescents aged 7-17 year. Dietary and waist circumference data were collected from the six rounds of the China Health and Nutrition Survey (CHNS) during 1997 to 2011. According to the research criteria of National Institute of Nutrition and Food Safety of Chinese Center for Disease Control and Prevention, precentral obesity/central obesity in children and adolescents was determined. Multivariate Logistic regression was used to analyze the relationship between macronutrient energy supply ratios and precentral obesity/central obesity.  Results  After adjusting confounders, the group with more than 30% fat supply increased the risk of precentral obesity/central obesity (OR=1.29, 95% CI: 1.12-1.48) compared with the group with fat energy supply less than 25%. Compared with the protein energy ratio less than 10% group, the ratio greater than or equal to 15% group increased the risk of precentral obesity/central obesity (OR=1.47, 95% CI: 1.19-1.82). The risk ofprecentral obesity/central obesity were both decreased in the 55% to 65% group (OR=0.75, 95% CI: 0.64-0.87) and ratio greater than or equal to 65% group (OR=0.68, 95% CI: 0.58-0.80) compared with the group with a carbohydrate energy supply ratio of less than 55%. The increased risk of precentral obesity/central obesity was greater in boys with protein energy ratio greater than or equal to 15% than in girls (OR=1.78, 95% CI: 1.31-2.41, interaction P=0.011).  Conclusion  Dietary structure of children and adolescents with lower carbohydrate energy ratio and higher fat and protein energy ratio increase the risk of precentral obesity/central obesity.
Study on the association of macronutrients intake with overweight and obesity among children and adolescents aged 7-17 years in China
SONG Wei-qi, NAN Ying, SUN Yu, WANG Jin-dong, LIANG Fen, ZHANG Wen-ting, LIU Dan, MAO Chen
2021, 25(5): 521-527. doi: 10.16462/j.cnki.zhjbkz.2021.05.006
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  Objective  To analyze the association of macronutrients intake with overweight and obesity among children and adolescents aged 7-17 years in China.  Methods  Children and adolescents aged 7-17 years who participated in China Health and Nutrition Survey from 1997 to 2011 with complete dietary and BMI data were included. Overweight and obesity were judged by experts from the Group of China Obesity Task Force. The Logistic regression method was applied to assess the association of macronutrients intake with overweight and obesity.  Results  A total of 6 360 Chinese children and adolescents were included, including 3 529 (55.5%) aged 7- < 12 years and 3 360 (52.8%) boys. Among them, 1 060 (16.7%) were overweight and obese. After controlling for potential confounders, when compared with fat energy supply ratio < 25%, the risk of overweight and obesity appeared an increase of 20% (OR=1.20, 95% CI: 1.03-1.41, P=0.023) with fat energy supply ratio ≥30%. Compared with protein energy supply ratio < 10%, it increased of 61% (OR=1.61, 95% CI: 1.25-2.04, P < 0.001) with protein energy supply ratio ≥15%. Compared with carbohydrate energy supply ratio < 55%, it decreased of 20% (OR=0.80, 95% CI: 0.68-0.95, P=0.011) and 21% (OR=0.79, 95% CI: 0.66-0.94, P=0.010) with carbohydrate energy supply ratio between 55%- < 65%, ≥65%, respectively. The higher energy supply ratios of fat and protein, and lower carbohydrate energy supply ratio had a stronger association with overweight and obesity (P < 0.05). For overweight and obesity, the association seemed to be stronger among boys with excessive intake of protein (P=0.034).  Conclusion  Excessive intakes of fat and protein may lead to overweight and obesity in children and adolescents.
Comparison of dietary energy intake and nutrient sources of Chinese children aged 6 to 17 years between 1982 and 2012
YANG Ti-ti, ZHANG Qian, WANG Lu-lu, XU Pei-pei, GAN Qian, CAO Wei, LI Li, XU Juan, HU Xiao-qi, HE Yu-na, WANG Yu-ying, WANG Hong-liang, PAN Hui, ZHAO Wen-hua
2021, 25(5): 528-533, 540. doi: 10.16462/j.cnki.zhjbkz.2021.05.007
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  Objective  To understand the dietary energy intake and energy nutrient sources and change characteristics of Chinese children aged 6 to 17 in 1982 and 2012.  Methods  The dietary intakes of children aged 6 to 17 years who participated in the dietary survey in the 1982 China National Nutrition Survey and the 2010-2013 Chinese Health and Nutrition Surveillance were analyzed. The dietary information in 1982 was collected using household food weighing accounting for 5 consecutive days, and the dietary information in 2012 was collected using a combination of 24-hour dietary recall and 3 days of household oil, salt, and condiment consumption weighing for 3 consecutive days.  Results  From 1982 to 2012, the average daily dietary energy intake of Chinese children aged 6 to 17 years decreased from (2 216.5±19.0) kcal/d to (1 766.4±30.6) kcal/d (t=45.05, P < 0.001); the ratio of energy from carbohydrate decreased from (73.7±0.4)% to (55.5±0.6)% (t=102.10, P < 0.001); the ratio of energy from protein increased from (10.8±0.1)% to (12.3±0.2)% (t=-33.40, P < 0.001); the ratio of energy from fat increased from (15.2±0.3)% to (33.2±0.5)% (t=-105.22, P < 0.001). The proportion of children aged 6 to 17 years whose ratio of energy from fat exceeded the upper limit (30%) of the acceptable macronutrient distribution range increased from 6.1% in 1982 to 59.8% in 2012.  Conclusions  From 1982 to 2012, the dietary energy intake of children aged 6 to 17 years in China decreased, and the ratios of energy from the three macronutrients changed, the ratio from carbohydrate decreased, and the ratios from protein and fat increased. It is necessary to make full use of the policy support, combining schools, families, and society to carry out extensive nutrition promotion and education, so as to guide children aged 6 to 17 years to eat rationally, and adjust the diet structure of children aged 6 to 17 years in urban and rural areas.
Study on the relationship between sugar-sweetened beverage intake and central obesity in children and adolescents aged 7-17 years from 1997 to 2011 in China
WANG Jin-dong, SUN Yu, SONG Wei-qi, LIANG Fen, NAN Ying, ZHANG Wen-ting, LIU Dan, HU Gui-fang, MAO Chen
2021, 25(5): 534-540. doi: 10.16462/j.cnki.zhjbkz.2021.05.008
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  Objective  To investgate the relationship between sugar-sweetened beverage intake and central obesity among children and adolescents.  Methods  We used the cross-sectional survey data from 1997 to 2011 in the open database of the "China Health and Nutrition Survey" project, and this study analyzed the relationship between sugar-sweetened beverage intake and central obesity among Chinese children aged 7-17 years. All participants were divided into normal group and pre-central obesity group/central obesity group by the waist circumference. We used the Chi-square test to compare the differences between different groups, and multivariate Logistic liner regression analysis model was used to analyze the influence of sugary drinks on central obesity in children and adolescents.  Results  Among 1 916 children aged 7 to 17 years, 389 (20.3%) had more than or equal to 3 times of intake of sugar-sweetened beverages per week, 712 (37.2%) had 1-2 times per week, 563 (29.4%) had 1-3 times per month and 252 (13.2%) had less than once a month group. A total of 731 cases (38.2%) developed pre-central obesity/central obesity. After adjusting for related confounding factors, compared with the group who consumes sugary drinks less than once a month group, the group had more than or equal to 3 times a week increased the risk of obesity by 68.0% (95% CI: 1.194-2.364, P=0.003). Besides, age and gender had no significant effect on the relationship between the frequency of sugar-sweetened beverage intake and central obesity.  Conclusion  Higher frequency of sugar-beverage intake can increase the risk of central obesity in children and adolescents.
Comparison of dietary intake of vitamin A among Chinese children aged 6 to 17 years between 1982 and 2012
GAN Qian, WANG Lu-lu, XU Pei-pei, YANG Ti-ti, CAO Wei, WANG Hong-liang, XU Juan, LI Li, HU Xiao-qi, SI Xiang, ZHAO Wen-hua, ZHANG Qian
2021, 25(5): 541-546. doi: 10.16462/j.cnki.zhjbkz.2021.05.009
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  Objective  Understanding dietary intake of vitamin A, retinol and carotenes among Chinese children aged 6-17 years (Hereinafter referred to as school-age children), providing basic data to promote their health condition.  Methods  This study analyzed data retrieved from China Nutrition Survey in 1982 and Chinese Residents' Nutrition and Health Survey in 2012. Food intakes per person per day were calculated, then the intake of retinol, carotenes and total vitamin A in school-aged children were obtained and compared to recommended nutrient intake (RNI) of vitamin A.  Results  From 1982 to 2012, total dietary vitamin A intake in children dropped from (333.3±15.9) μg RAE to (215.3±9.5) μg RAE (F=61.95, P < 0.001), and retinol intake increased from (28.4 ±2.0) μg to (107.6±4.8) μg (F=225.36, P < 0.001), and carotenes intake decreased from (3 673.9±217.3) μg to (1 297.4±82.0) μg (F=214.98, P < 0.001). In 1982, children from rural areas had higher total vitamin A intake than children from urban areas (F=5.28, P=0.022). While total vitamin A intake in children from urban areas became higher than children from rural areas in 2012 (F=14.85, P < 0.001). Only one quarter of the children's dietary vitamin A intake reached 80% RNI in 2012.  Conclusions  The total dietary intake of vitamin A declined from 1982 to 2012. The proportion of plant-based foods contributing to total vitamin A dropped, while the proportion of animal foods contributing to total vitamin A grew up from 1982 to 2012. Next actions should be adopted to enhance nutrition and health education, increase the variety of food supply in rural areas.
Original Articles
The mediating effect of serum uric acid on the association of fat intake with renal dysfunction among Chinese adults
ZHENG Han, TIAN Lu, LI Yan-zhi, JIA Chong-qi
2021, 25(5): 547-551. doi: 10.16462/j.cnki.zhjbkz.2021.05.010
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  Objective  To evaluate the association of high-fat diet with renal dysfunction and the mediating effect of serum uric acid.  Methods  Total 8 187 adult participants from the China Health and Nutrition Survey (CHNS) in 2009 with blood specimens were included in this national cross-sectional study. Renal dysfunction was defined as the estimated glomerular filtration rate (eGFR) < 60 ml/(min/1.73 m2). The fat intake level was assessed by the percentage of fat intake in total energy intake. Restrictive cubic spline (RCS) regression based on binary logistic regression analyses was used to explore the dose-response relationship between fat intake and renal dysfunction. Mediation analysis was conducted based on the Karlson-Holm-Breen method using Logistic regression.  Results  There was a linear positive relationship between fat intake level and the risk of renal dysfunction (β=0.015, 95% CI: 0.007-0.023, P < 0.001). The mediating effect of serum uric acid accounted for 13.33% of total effect of fat intake level on risk of renal dysfunction (P=0.014).  Conclusions  Increased fat intake level may increase the risk of renal dysfunction among Chinese adults, and serum uric acid may play a statistically significant mediatory role in the relationship between high-fat diet and renal dysfunction.
Joint association of dietary pattern and socioeconomic status with the 10-year risk of cardiovascular disease
CHEN Yang-yang, NA Xiao-na, MA Xiao-chuan, HUA Yu-meng, ZHU Zhu, ZHOU Gui-rong, LIU Ai-ping
2021, 25(5): 552-558, 588. doi: 10.16462/j.cnki.zhjbkz.2021.05.011
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  Objective  To investigate the joint association of dietary pattern and socioeconomic status with the 10-year risk of cardiovascular disease, and to provide guidance for prevention and control of cardiovascular disease.  Methods  A questionnaire survey was conducted among 2 431 residents in the Mentougou District of Beijing, in which multi-stage sampling methods were used. Univariate analysis was performed to explore the relationships between dietary patterns, socioeconomic status, and the 10-year risk of cardiovascular disease. Furthermore, multivariable logistic regression was used to assess the joint association of both dietary pattern and socioeconomic status with the 10-year risk of cardiovascular disease.  Results  The proportion of the 10-year medium-to-high risk of cardiovascular disease among permanent residents in the Mentougou District of Beijing was 38.46%. People with high-salt-and-alcohol dietary pattern (48.93%) and low socioeconomic status (58.47%) had a higher proportion of 10-year medium-to-high risk of cardiovascular disease (all P < 0.001). After adjusting confounding factors, in comparison to people with both balanced dietary pattern and high socioeconomic status, the proportion of the 10-year medium-to-high risk of cardiovascular disease of people with both high-salt-and-alcohol dietary pattern and low socioeconomic status was highest (OR=6.841, 95% CI: 4.518~10.540, P < 0.001).  Conclusions  Balanced diet promotion should consider socioeconomic status. We ought to encourage a balanced diet combined with actual conditions of different socioeconomic status to prevent and control cardiovascular disease in the real world.
Study on influencing factors of congenital heart disease in children aged 0-6 years based on case-control and dose-esponse relationship
YAN Huan, CAO Yong-wen, YE Jia-xin, SHEN Yan-fei, GE Xiao-jie, YANG Na, LIU Qian-qian, WU-YANG Hao-tian, HAN Xue-mei
2021, 25(5): 559-565. doi: 10.16462/j.cnki.zhjbkz.2021.05.012
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  Objective  By analyzing the non-genetic factors of congenital heart disease (CHD) in children aged 0 to 6 years in Gansu Province, suggestions were put forward to prevent CHD in children.  Methods  We chose 29 566 children aged 0 to 6 from 5 districts and counties in Gansu Province from September to December 2016 by stratified isometric sampling method. We selected 106 children with CHD as the case group, and randomly selected 318 children of the same age, gender and living environment from healthy children as the control group for 1∶3 case-control matching. Then, we used logistic regression analysis method fitted by Cox proportional hazard model to analyze the influencing factors of CHD in children. At the same time, the dose-response relationship between birth weight and CHD disease in children was analyzed using a restrictive cubic spline model.  Results  Low birth weight (P= 0.028), low educational level of the mother (P=0.035), consumption of salted food (P=0.007), medical abortion history (P=0.001), ovulation medication before pregnancy (P < 0.001), consumption of fish during pregnancy (P=0.020) and appropriate physical exercise (P < 0.001) were related to the risk of CHD in children. The results of restrictive cubic spline response analysis showed a linear dose-response relationship between birth weight and congenital heart disease (overall trend P < 0.001, non-linear P=0.246).  Conclusions   It is suggested that women of childbearing age should take pre-pregnancy examination and rationally use ovulatory drugs. Pregnant women should pay attention to health care and screening during pregnancy, eat more fish, shrimp and other seafood, not eat salted and dried food, take physical exercise appropriately and strengthen the study of maternal and child health care knowledge to reduce the risk of congenital heart disease in children.
The association between physical activity and the risk of hypertension and diabetes among adults in Liaoning Province in 2016
YOU Yi, PAN Lei-lei, MA Ying-shun, TIAN Jiang
2021, 25(5): 566-570,576. doi: 10.16462/j.cnki.zhjbkz.2021.05.013
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  Objective  To survey the association between physical activity and the risk of hypertension and diabetes among adults in Liaoning Province, and to provide evidence for prevention of hypertension and diabetes.  Methods  34 989 samples were selected through multistage stratified and clustered random sampling from July to September 2016. A face-to-face standard questionnaire and physical examination were applied to each sample. Logistic regression analysis model was applied to explore the association between physical activity and the risk of hypertension and diabetes.  Results  The prevalence of hypertension and diabetes was 26.9% and 11.3%, and standardized prevalence was 23.0% and 9.8%. The median of total physical activity time, traffic physical activity time and moderate professional physical activity time was 490(210, 1 000) min, 150(0, 420) min and 40(0, 420) min per week, respectively. The rates of residents with active, sufficient and insufficient physical levels were 38.1%, 35.8% and 26.1%, respectively. After adjusting confounding factors, logistic regression analysis models showed that residents with insufficient level of physical activity were significantly more likely to have hypertension (OR=1.146, 95% CI: 1.076-1.220, P < 0.001) and diabetes (OR=1.148, 95% CI: 1.055-1.249, P=0.001).  Conclusions   The prevalence of hypertension is moderate among adults in Liaoning Province, while the prevalence of diabetes is relatively high. The proportion of residents with insufficient physical activity is relatively high. Insufficient physical activity is a risk factor for hypertension and diabetes. Increasing physical activity level in residents of senior, low-education or urban groups should be integrated into hypertension and diabetes prevention strategies.
Incidence trend of hepatitis B among people aged 0-10 years in China from 2004 to 2017
WANG Peng-ju, YU Li, WANG Yi-hui, CUI Xu-dong, CAO Yan-wen, LI Shao-xuan, GAO Yin-yan, DING Guo-wu
2021, 25(5): 571-576. doi: 10.16462/j.cnki.zhjbkz.2021.05.014
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  Objective  To analyze the incidence trend of hepatitis B among people aged 0-10 years old in China from 2004 to 2017.  Methods  The data of hepatitis B incidence among people aged 0-10 years old from 2004 to 2017 was used from the National Public Health Science Data Center. The incidence trend was analyzed by Joinpoint regression, and the average percent change and the annual percent change were calculated. At the same time, the age-period-cohort model was constructed to analyze the impalt of age, period and birth cohort on the trend of hepatitis B.  Results  From 2004 to 2017, there were 170 700 new cases of hepatitis B among the 0-10 years old in China, and the incidence rate was 7.74/100 000. Besides, the results of Joinpoint regression showed that the incidence rate of hepatitis B among people aged 0-10 years old presented a general downward trend from 2004 to 2017 (AAPC=-12.060 45, P < 0.001), and there was an irregular change from 2015 to 2017 (APC=2.28, P=0.9077). Birth cohort analysis showed that the incidence rate of hepatitis B was lower in the later generation. Meanwhile, the results of the age-period-cohort model showed that the incidence rate of hepatitis B among the 0-10 years old population was significantly influenced by age, period and cohort (all P < 0.001).  Conclusions   From 2004 to 2017, the incidence of hepatitis B among people aged 0-10 years old in China has decreased continuously, and the downward trend has slowed down. It is suggested to strengthen the prevention and control of hepatitis B in order to reduce the risk of hepatitis B.
Analysis of COVID-19 outbreak based on Window-Time-LSTM Model
CHENG Ning, DING Chang-song, GAO Wan-qing, LIU Jia-jun
2021, 25(5): 577-582. doi: 10.16462/j.cnki.zhjbkz.2021.05.015
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  Objective  To solve the data difference between COVID-19 confirmed cases and actual number of COVID-19 infections, a new model is proposed to predict the spread of the disease. The data difference has been mainly caused by insufficient understanding in the early stage of transmission, limited detection capabilities and the long incubation period.  Methods  The historical data of the number of confirmed cases are analyzed based on Window-Time. A Long Short-Term Memory (LSTM) network model is combined with the Window-Time strategy to analyze and predict the actual number of infections according to data published of various regions in the world.  Results  The LSTM network model with Window-Time strategy has higher accuracy than other models. Tuning the width of the Window-Time to the width of 5, the prediction result shows that it is closest to the real actual number of infections, which is consistent with the incubation period of COVID-19 generally known as 3-7 days.  Conclusion  This method provides a reference for the analysis of the transmission rate of COVID-19 and the incubation period of the epidemic.
Associations between preschool children's hyperactive behaviors, parents' type D personality and family environment
ZHAO Ya-fen, HE Guan-hao, HUANG Li-hua, XIAN Dan-xia, YANG Wei-kang, CHEN Wei-qing
2021, 25(5): 583-588. doi: 10.16462/j.cnki.zhjbkz.2021.05.016
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  Objective  To explore the associations with children's hyperactive behaviors and parental type D personality (TDP) and family environment.  Methods  A cross-sectional survey was conducted among children from LongHua District of Shenzhen in China during 2016-2017. Multiple linear regression analysis was employed to assess the associations with children's hyperactive behaviors, parental TDP and family environment. Mediation analysis was applied to explore the mediating role of family environment on the associations between parental TDP and children's hyperactive behaviors.  Results  Parental TDP was positively associated with the conflict dimension (maternal: β=0.687; paternal: β=0.694) and children's hyperactive behaviors (maternal: β=0.164; paternal: β=0.130), while it was negatively correlated with the cohesion (maternal: β=-0.654; paternal: β=-0.665), intellectual-cultural orientation (maternal: β=-0.537; paternal: β=-0.394) and organization (maternal: β=-0.589; paternal: β=-0.459) in family context. Children's hyperactive behaviors were negatively associated with the cohesion (β=-0.010), intellectual-cultural orientation (β=-0.033), organization (β=-0.022) in family context, but positively related to the conflict dimension (β=0.034). The cohesion, conflict dimension, intellectual-cultural orientation and organization of family environment partially mediated the relationship between parental TDP and children's hyperactive behaviors, with the proportion of mediation effect from 4.88 to 20.00%.  Conclusion  Maternal and paternal TDP can increase hyperactive behaviors among children, which partially through creating different family environment.
A study on the interaction of snoring and body mass index on hypertension
DING Shuai, MIAO Wei-gang, QIN Yu, SU Jian, CUI Lan, DU Wen-cong, ZHOU Jin-yi, WU Ming
2021, 25(5): 589-593. doi: 10.16462/j.cnki.zhjbkz.2021.05.017
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  Objective  To analyze the interaction between snoring and body mass index (BMI) on hypertension, and to develop appropriate prevention strategies.  Methods  Based on the preliminary screening data of 82 751 residents aged ≥35 in the China Peace-MPP program for High-risk Cardiovascular Disease population in Jiangsu Province from September 2015 to June 2018, logistic regression analysis was used to evaluate the impact of snoring and body mass index on hypertension, and the interaction between snoring and BMI was further analyzed.  Results  Among the subjects, the prevalence of snorers was 45 013 (54.40%), hypertension was 47 295 (57.15%), people with BMI≥24 kg/m2 was 52 641 (63.61%). People who snored and high BMI were at higher risk for hypertension, the odds ratio (OR) was 1.686(95% CI: 1.635-1.738)and 2.242 (95% CI: 2.172-2.313), respectively. Snoring and BMI were found to have synergistic effects on hypertension (RERI=1.160, AP=0.311, S=1.738). The risk of hypertension was 3.732 times greater when these factors both were present compared with neither was present (95% CI: 3.582-3.888).  Conclusions   Both snoring and overweight increased the risk of hypertension, with synergistic effects. Health education and blood pressure monitoring should be carried out for people who snored and overweight to prevent the occurrence of hypertension and cardiovascular diseases.
The role of maternal adverse childhood experiences on the sleep quality of preschool children
WANG Xiao-yan, YIN Gang-zhu, SHAO Zi-yu, GUO Feng, HU Hai-li, JIANG Zhi-cheng, LI Shu-qin, LI Ruo-yu, WAN Yu-hui
2021, 25(5): 594-599. doi: 10.16462/j.cnki.zhjbkz.2021.05.018
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Abstract:
  Objective  To analyze the correlation between maternal adverse childhood experiences (ACEs) and sleep quality of preschool children.  Methods  Using stratified cluster sampling, 7 318 preschool children were selected from 4 main urban areas, 3 development zones, 3 counties and 1 prefecture-level City of Hefei. Investigation was carried out using the ACEs Questionnaire and the Children's Sleep Assessment Questionnaire. A multivariate logistic regression model was established to analyze the correlation between maternal ACEs and the sleep quality of preschool children.  Results  The detection rate of poor sleep quality in preschool children was 34.31%. After adjusting the parity, parents' educational level, parents' occupation and family structure, the detection rate of poor sleep quality of preschool children in the maternal ACEs group was higher than that in the non-maternal ACEs group, [OR(95% CI) = 1.62 (1.45-1.81), P < 0.05]. Maternal ACEs were correlated with increased risk of poor sleep quality in preschool boys and girls [boys: OR(95% CI)=1.66(1.42-1.93); girls: OR(95% CI)= 1.58(1.35-1.86); all P < 0.05].  Conclusions   Maternal ACEs are correlated with poor sleep quality of preschool children. Therefore, to promote sleep health of preschool children, we need to pay attention to the intergenerational effect of maternal ACEs.
The association between sleep duration, eating habits and obesity of school-aged children
ZENG Xiang-yu, HUANG Yan, LIU Si-bo, CHEN Hui
2021, 25(5): 600-604,611. doi: 10.16462/j.cnki.zhjbkz.2021.05.019
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Abstract:
  Objective  This study aims to explore associations between sleep duration, eating habits and childhood obesity among children aged 6-14 years.  Methods  We used multi-stage stratified cluster sampling to selected 10 primary and secondary schools in Maoming City, Guangdong Province to collect information of children's demography, sleep duration, eating habits, height and weight via self-reported questionnaire and anthropometric measurement.  Results  The obesity prevalence among 5 179 children was 14.02%. The prevalence of boys was significantly higher than that of girls. 40.75% of children were lack of sufficient nighttime sleep duration. Compared with children aged above 12 years, children aged 6-11 years had higher rate of insufficient sleep time. There was a negative correlation between children's nighttime sleep duration and high-risk diet scores (r=-0.112, P < 0.001). The results of multivariate logistic regression analysis showed that sufficient night sleep duration and longer eating duration can reduce the risk of obesity in male students, yet this association was not significant in female students.  Conclusions  Sleep duration and eating habits are independent factors related with children's obesity. Interventions in childhood obesity should recommend adequate sleep duration and healthy eating habits.
Review
Research progress on the epidemiology of hand, foot and mouth disease caused by Coxsackievirus A6
ZHANG Wan-xue, LIU Jue
2021, 25(5): 605-611. doi: 10.16462/j.cnki.zhjbkz.2021.05.020
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Abstract:
Since 2008, outbreaks of hand, foot and mouth disease caused by Coxsackievirus A6 (CVA6) were found worldwide. CVA6 has gradually become one of the predominant pathogens of hand, foot and mouth disease. As an emerging pathogen of hand, foot and mouth disease, there is no vaccine to prevent CVA6 effectively. Not only children but also adults are susceptible to CVA6, which is prone to recombination and mutation and often causes atypical symptoms, such as onychomadesis. Therefore, hand, foot and mouth disease caused by CVA6 has become a major challenge in the prevention and control of hand, foot and mouth disease. This article reviewed the research progress of its etiological and epidemic features, influencing factors, prevention and control measures of CVA6, in order to provide scientific basis for the prevention and control measures of hand, foot and mouth disease caused by CVA6.
Short Reports
Epidemiological characteristics of injured children aged 0-6 years in Gansu Province from 2016 to 2018
ZHANG Jing, ZHANG Chou-ji, DONG Cai-xia
2021, 25(5): 612-615. doi: 10.16462/j.cnki.zhjbkz.2021.05.021
Abstract(468) HTML (263) PDF(57)
Abstract:
  Objective  To explore epidemiological characteristics of injury among children aged 0-6 years in Gansu Province, so as to provide scientific basis for the prevention and control of child injury.  Methods  Epidemiological analysis was applied by using the children's injury data collected from injury surveillance hospitals through 2016 to 2018.  Results  A total of 7 054 effective cases of injured children aged 0-6 years were collected, and the male-female ratio was 1.5∶1. The top three causes of injury were falls (42.2%), burns (31.5%) and blunt injury (7.2%). The top location injury occurred was home(78.7%). The most common injured positions were head(41.9%), upper limbs(24.6%), lower limbers(13.6%).68.9% of children injuries were minor, and 75.6% went home after the treatment.  Conclusions  More injuries occured in boys than in girls aged 0-6 years, and the top cause of injury was falling. The injury occurred mainly at home, and the top injured position was head. The preventive measures should be taken according to the characteristics of injury among children aged 0-6 years.
Unintentional falls mortality among the elderly in Yunnan Province between 2015 and 2019
LI Ben-yan, DENG Rui, TANG Xian, YANG Yong-fang, HUANG Yuan, QIN Ming-fang
2021, 25(5): 616-620. doi: 10.16462/j.cnki.zhjbkz.2021.05.022
Abstract(398) HTML (195) PDF(51)
Abstract:
  Objective  To explore the trend of unintentional falls mortality among the elderly aged over 60 years in Yunnan Province from 2015 to 2019, and to provide the evidence for developing specific interventions.  Methods  Data on deaths from unintentional falls were extracted from Yunnan Disease Surveillance Points System from 2015 to 2019. The trends of unintentional falls mortality among the elderly were statistically described by descriptive epidemiology.  Results  From 2015 to 2019, a total of 22 799 deaths from unintentional falls were reported among the elderly in Yunnan Province. The age-standardized mortality rates of unintentional falls increased from 59.00/100 000 in 2015 to 94.98/100 000 in 2019, which had shown an upward trend over the five years. The reported mortality rates of unintentional falls were generally higher for males than females, which were 140.18 and 111.62 per 100 000 respectively in 2019. The reported mortality rates in urban areas (110.33/100 000) were higher than rural areas (89.70/100 000) in 2019. The mortality rate of unintentional falls increased with the increase of age, and the mortality peak occured among the elderly over 80 years old. The unintentional falls mainly occurred at home, accounting for 61.19% of total falls, and the most common place of death from unintentional falls was at home as well, accounting for 84.18% of total unintentional deaths.  Conclusions  The unintentional falls mortality rate among the elderly in Yunnan Province showed an increasing trend from 2015 to 2019. The male and urban residents with an advanced age should be the target groups for further interventions. To reduce the unintentional falls and the deaths caused by it, the specific preventive strategies might be developed with a consideration of providing health education, creating age-friendly living environment, and improving healthcare accessibility for the elderly in Yunnan.

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