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The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.

Background China has seen rapid increase in obesity and hypertension prevalence and fast food consumption over the past decade. We examined status and risk factors for Western- and Chinese fast food consumption and their associations with health outcomes in Chinese children, and examined how maternal factors were associated with child health outcomes. Methods Data of 1626 students aged 7–16 (11.6 ± 2.0) years and their parents in four mega-cities across China (Beijing, Shanghai, Nanjing, and Xi’an) were collected in the 2015 baseline survey of the Childhood Obesity Study in China Mega-cities. Weight, height, waist circumference, and blood pressure were measured. Food intake was assessed using questionnaire. Mixed models were used to examine the associations. Results Among the children, 11.1% were obese, 19.7% were centrally obese, and 9.0% had hypertension. Obesity prevalence was much higher in boys than in girls (15.2% vs. 6.9% and 27.4% vs. 11.7%, respectively, both P  < 0.001). About half (51.9% and 43.6%) of children consumed Western and Chinese fast food, respectively, over the past 3 months. Compared to those with college or above maternal education level, those with elementary school or below maternal education level were 49% more likely to consume Western fast food (odds ratio [OR] and 95% confidence interval [CI]: 1.49 [1.10–2.03]). Chinese fast food consumption rate increased by 12% with each year of increase in child’s age (OR and 95% CI: 1.12 [1.02–1.23]). No significant associations between fast food consumption and health outcomes were detected. Adjusting for Western fast food consumption, children with lower maternal education were 71% and 43% more likely to have obesity and central obesity (ORs and 95% CIs: 1.71 [1.12–2.61] and 1.43 [1.00–2.03], respectively), and maternal body mass index was positively associated with child obesity, central obesity, and hypertension (ORs and 95% CIs: 1.11 [1.06–1.17], 1.12 [1.07–1.17], and 1.09 [1.03–1.15], respectively). Results were similar when Chinese fast food consumption was adjusted for. Conclusions The prevalence of fast food consumption, obesity and hypertension is high among children in major cities in China. Maternal factors affect child outcomes.

Background School neighborhood food environment is recognized as an important contributor to childhood obesity; however, large-scale and longitudinal studies remain limited. This study aimed to examine this association and its variation across gender and urbanicity at multiple geographic scales. Methods We used the US nationally representative Early Childhood Longitudinal Study–Kindergarten cohort data and included 7530 kindergarteners followed up from 1998 to 2007. The Census, road network, and Dun and Bradstreet commercial datasets were used to construct time-varying measurements of 11 types of food outlet within 800-m straight-line and road-network buffer zones of schools and school ZIP codes, including supermarket, convenience store, full-service restaurant, fast-food restaurant, retail bakery, dairy product store, health/dietetic food store, candy store, fruit/vegetable market, meat/fish market, and beverage store. Two-level mixed-effect and cluster-robust logistic regression models were performed to examine the association. Results A higher body mass index (BMI) in 2007 was observed among children experiencing an increase of convenience stores in school neighborhoods during 1998–2007 ( β  = 0.39, p  < 0.05), especially among girls ( β  = 0.50) and urban schoolchildren ( β  = 0.41), as well as among children with a decrease of dairy product stores ( β  = 0.39, p  < 0.05), especially among boys ( β  = 1.86) and urban schoolchildren ( β  = 0.92). The higher obesity risk was associated with the increase of fast-food restaurants in urban schoolchildren (OR = 1.27 [95% CI = 1.02–1.59]) and of convenience stores in girls (OR = 1.41 [95% CI = 1.09–1.82]) and non-urban schoolchildren (OR = 1.60 [95% CI = 1.10–2.33]). The increase of full-service restaurants was related to lower obesity risk in boys (OR = 0.74 [95% CI = 0.57–0.95]). The decrease of dairy product stores was associated with the higher obesity risk (OR = 1.68 [95% CI = 1.07–2.65]), especially boys (OR = 2.92 [95% CI = 1.58–5.40]) and urban schoolchildren (OR = 1.67 [95% CI = 1.07–2.61]). The schoolchildren exposed to the decrease of meat/fish markets showed the lower obesity risk (OR = 0.57 [95% CI = 0.35–0.91]), especially urban schoolchildren (OR = 0.53 [95% CI = 0.32–0.87]). Results from analyses within 800-m straight-line buffer zones of schools were more consistent with our theory-based hypotheses than those from analyses within 800-m road-network buffer zones of schools and school ZIP codes. Conclusions National data in the USA suggest that long-term exposure to the food environment around schools could affect childhood obesity risk; this association varied across gender and urbanicity. This study has important public health implications for future school-based dietary intervention design and urban planning.

Purpose The aim of this paper is to review the evidence of the association between energy balance and obesity. Methods In December 2015, the International Agency for Research on Cancer (IARC), Lyon, France convened a Working Group of international experts to review the evidence regarding energy balance and obesity, with a focus on Low and Middle Income Countries (LMIC). Results The global epidemic of obesity and the double burden, in LMICs, of malnutrition (coexistence of undernutrition and overnutrition) are both related to poor quality diet and unbalanced energy intake. Dietary patterns consistent with a traditional Mediterranean diet and other measures of diet quality can contribute to long-term weight control. Limiting consumption of sugar-sweetened beverages has a particularly important role in weight control. Genetic factors alone cannot explain the global epidemic of obesity. However, genetic, epigenetic factors and the microbiota could influence individual responses to diet and physical activity. Conclusion Energy intake that exceeds energy expenditure is the main driver of weight gain. The quality of the diet may exert its effect on energy balance through complex hormonal and neurological pathways that influence satiety and possibly through other mechanisms. The food environment, marketing of unhealthy foods and urbanization, and reduction in sedentary behaviors and physical activity play important roles. Most of the evidence comes from High Income Countries and more research is needed in LMICs.

Study the trends in Western fast food consumption (FFC) among Chinese school-age children and the association between FFC and obesity using nationwide survey data. Cross-sectional and longitudinal analyses were conducted to study the trends in FFC and the associations between FFC and weight status (overweight, obesity and body mass index (BMI) z-score). Longitudinal data from families were collected in the 2004 and 2009 China Health and Nutrition Survey (covering nine provinces throughout China). The analysis included 2656 Chinese children aged 6 to 18 years (1542 and 1114 children in the 2004 and 2009 survey, respectively). FFC (reported having consumed Western fast food in the past three months) has increased between 2004 and 2009, from 18.5% to 23.9% in those aged 6-18, and increased more rapidly among those aged 13-17, from 17.9% to 26.3%. The increase was significant in almost all groups by age, sex, family income, and residence. Our cross-sectional and longitudinal analyses did not detect a significant association between FFC and obesity/overweight or BMI z-score (e.g., for BMI z-score, boys: β = 0.02, 95% CI: -0.71, 0.75; girls: β = -0.14, 95% CI: -1.03, 0.75). FFC has increased in Chinese school-age children, especially in older children, boys, and those from low- and medium-income families, rural areas, and East China, but decreased among those from high-income families during 2004-2009. The data did not show a significant association between FFC and obesity.

Hydroxyapatite (HAP), similar to inorganic phase in bones, shows good biocompatibility and bioactivity as bone defect repairing material. Recently, nanoscaled HAP shows the special properties differing from bulk HAP in physics, chemistry and biology. This paper demonstrates that HAP nanoparticle (nHAP) possesses the ability for inhibiting cancer cell growth in vitro and in vivo . In vitro , after treatment with nHAP for 3 days, proliferation of human cancer cells are inhibited by more than 65% and by less than 30% for human normal cells. In vivo , injection of nHAP in transplanted tumor results in significant reduction (about 50%) of tumor size. The anticancer effect of nHAP is mainly attributed to high amount by endocytosis in cancer cells and inhibition on protein synthesis in cells. The abundant nHAP internalized in cancer cells around endoplasmic reticulum may inhibit the protein synthesis by decreasing the binding of mRNA to ribosome due to its high adsorption capacity for ribosome and arrest cell cycle in G0/G1 phase. nHAP shows no ROS-involved cytotoxicity and low cytotoxicity to normal cells. These results strongly suggest that nHAP can inhibit cancer cell proliferation and have a potential application in cancer treatment.

Background The geographic information science-based interactive map provided good prospects for the public health to study disease prevalence. The purpose of this study is to understand global spatial–temporal trends of childhood overweight and obesity and underlying causes help formulating intervention strategies. Methods This multiple cross-sectional study included data on childhood overweight and obesity prevalence, gross national income per capita, and urbanization rate for 191 countries from 1975–2016. Autoregressive integrated moving average model, standard deviational ellipse model and mixed-effects models were used to explore spatial–temporal trends of childhood overweight and obesity and associations with gross national income per capita and urbanization rate. Results Globally, childhood overweight and obesity rate would reach 30.0% in 2030 (boys: 34.2%, girls: 27.4%). By 2030, it would reach 58.3% in middle- and high-income countries and 68.1% in Western Pacific region. Spatial–temporal trendline for childhood overweight and obesity in 1975–2030 exhibited a “C” shape, migrating from 1975 (15.6 。 E, 24.6 。 N) to 2005 (10.6 。 E, 21.7 。 N), then to 2030 (14.8 。 E, 17.4 。 N). The trendline for urbanization rate was also an irregular \"C\", and the turning point appeared five years earlier than childhood overweight and obesity. Conclusions Globally, childhood overweight and obesity prevalence will continue to increase. Its weight mean center migrated from western countries to Asia and Africa following economic development.

Objectives. We explored the association between community racial/ethnic composition and obesity risk. Methods. In this cross-sectional study, we used nationally representative data from the Medical Expenditure Panel Survey linked to geographic data from the US Decennial Census and Census Business Pattern data. Results. Living in communities with a high Hispanic concentration (≥ 25%) was associated with a 0.55 and 0.42 increase in body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) and 21% and 23% higher odds for obesity for Hispanics and non-Hispanic Whites, respectively. Living in a community with a high non-Hispanic Asian concentration (≥ 25%) was associated with a 0.68 decrease in BMI and 28% lower odds for obesity for non-Hispanic Whites. We controlled for individual- and community-level social, economic, and demographic variables. Conclusions. Community racial/ethnic composition is an important correlate of obesity risk, but the relationship differs greatly by individual race/ethnicity. To better understand the obesity epidemic and related racial/ethnic disparities, more must be learned about community-level risk factors, especially how built environment and social norms operate within communities and across racial/ethnic groups.

Background This study tentatively constructs a composite measure of Chinese Healthy Ageing Index (CHAI) among older adults aged 60+ and investigates change of CHAI during 2011–2015 and its association with sociodemographic characteristics. Methods Data collected from 8182 old adults aged 60+ in the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS, a nationally representative sample) were used. Six medical measures of blood pressure, peak expiratory flow, cognitive status score, fasting glucose, kidney function and C-reactive function were used to construct CHAI (range 0–12, 0–2 = healthiest, 7–12 = unhealthiest). Ordinary least squares, logistic and random effects models examined social and spatial determinants of CHAI score and the prevalence of the ideal CHAI. Unconditional quantile regression tested heterogeneous impacts of sociodemographic determinants of CHAI score. Results Mean CHAI score declined from 5.7 to 5.2, and the proportion of the ideal CHAI (CHAI score = 0–2) increased from 5.6 to 9.4% during 2011–2015, indicating an improvement in healthy ageing over time. During 2011–2015, the highest rates of the ideal CHAI were in Southeast and East of China. Older adults, male, living in the Center and West, smoking, obesity/overweight and having chronic diseases were positively associated with total CHAI score and negatively with a higher prevalence of the ideal CHAI. Being married, having high education and regular social activities were associated with a higher rate of the ideal CHAI. The positive predictors for total CHAI were stronger in those with worse CHAI status. Conclusions In China healthy ageing has improved during 2011–2015, but substantial geographical and sociodemographic heterogeneities exist in the improvements, suggesting health equality remains a challenge in China. Future policies and interventions should especially focus on men, those in Central and West China, and combat health problems like obesity, chronic diseases and unhealthy behaviors.

Childhood obesity has been increasing rapidly worldwide. There is limited evidence for effective lifestyle interventions to prevent childhood obesity worldwide, especially in developing countries like China. The objective of this study was to assess the effectiveness of a school-based multi-component lifestyle childhood obesity prevention program (the CLICK-Obesity study) in Mainland China. A cluster randomized controlled trial was developed among grade 4 students from 8 urban primary schools (638 students in intervention, 544 as control) in Nanjing City, China. Students were randomly allocated to the control or intervention group at school-level. A one-year multi-component intervention program (classroom curriculum, school environment support, family involvement and fun programs/events) together with routine health education was provided to the intervention group, while the control group received routine health education only. The main outcome variables assessed were changes in body mass index, obesity occurrence, obesity-related lifestyle behaviors and knowledge. Overall, 1108 (93.7%) of the 1182 enrolled students completed the intervention study. The intervention group had a larger marginal reduction than did the control group in overall mean BMI value (-0.32±1.36 vs. -0.29±1.40, p = 0.09), although this was not significant. Compared with the control group, the intervention group was more likely to decrease their BMI (OR = 1.44, 95%CI = 1.10, 1.87) by 0.5 kg/m2 or above, increase the frequency of jogging/running (OR = 1.55, 95%CI = 1.18, 2.02), decrease the frequency of TV/computer use (OR = 1.41, 95%CI = 1.09, 1.84) and of red meat consumption (OR = 1.50, 95%CI = 1.15, 1.95), change commuting mode to/from school from sedentary to active mode (OR = 2.24, 95%CI = 1.47, 3.40), and be aware of the harm of selected obesity risk factors. The school-based lifestyle intervention program was practical and effective in improving health behaviors and obesity-related knowledge for children in China. This study provides important policy implications on school-based intervention programs for modifications of obesity-related lifestyles. Chinese Clinical Trial Registry ChiCTR-ERC-11001819.