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Understanding the changing profiles of cardiovascular disease (CVD) and modifiable risk factors is essential for CVD prevention and control. We aimed to report the comprehensive trends in CVD and risk factors in China from 1990 to 2019. Data on the incidence, death, and disability-adjusted life years (DALYs) of total CVD and its 11 subtypes for China were obtained from the Global Burden of Disease Study 2019. The CVD burden attributable to 12 risk factors was also retrieved. A secondary analysis was conducted to summarize the leading causes of CVD burden and attributable risk factors. From 1990 to 2019, the number of CVD incidence, death, and DALYs considerably increased by 132.8%, 89.1%, and 52.6%, respectively. Stroke, ischemic heart disease, and hypertensive heart disease accounted for over 95.0% of CVD deaths in 2019 and remained the top three causes during the past 30 years. Between 1990 and 2019, the age-standardized rate of stroke decreased significantly (percentage of decreased incidence: -9.3%; death: -39.8%; DALYs: -41.6%), while the rate of ischemic heart disease increased (percentage of increased incidence: 11.5%; death: 17.6%; DALYs: 2.2%). High systolic blood pressure, unhealthy diet, tobacco, and air pollution continued to be the major contributors to CVD deaths and DALYs (attributing to over 70% of the CVD burden), and the high body mass index (BMI)-associated CVD burden had the largest increase between 1990 and 2019. The significant increases in the number of CVD incident cases, deaths, and DALYs suggest that the CVD burden is still a concern. Intensified strategies and policies are needed to maintain promising progress in stroke and to reduce the escalating burden of ischemic heart disease. The CVD burden attributable to risk factors has not yet made adequate achievements; even worse, high BMI has contributed to the increasing CVD burden.

Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.

ObjectiveTo investigate the performance of weight/heightn in discriminating obesity-related cardio-metabolic risks, and compare their performance with BMI in Chinese and American children.Methods57,201 Chinese children aged 7–18 and 10,441 American children aged 12–18 with complete record of sex, age, height, weight, and waist circumference were included. Analyses and comparisons of BMI, weight/height2.5, and weight/height3 were predominantly discussed, while BMI z score, converted by BMI based on 2007 WHO growth standard, was set as the reference. Log-binomial regression models and areas under receiver-operating characteristic curves were used to examine their abilities on identifying cardio-metabolic risks, including elevated blood pressure, impaired fasting glucose, and dyslipidemia. Misclassification rates of each index were calculated.ResultsWeight/height3 is relatively stable during childhood in both populations. Odds ratio of weight/height3 in discriminating cardio-metabolic risks ranged from 1.09 (95% CI: 1.04, 1.14) to 1.23 (95% CI: 1.22, 1.25) and 1.06 (95% CI: 1.04, 1.08,) to 1.17 (95% CI: 1.15, 1.20) in Chinese and American participants, respectively. When 85th and 95th percentiles were set as thresholds for each sex, weight/height3 showed similar accuracy to BMI percentiles, and were more precise than BMI z scores. Misclassification rates of weight/height3 ranged from 19.1% (95% CI: 18.8%, 19.5%) to 34.7% (95% CI: 34.0%, 35.4%) compared to BMI z score, which ranged from 26.3% (95% CI: 26.0%, 26.7%) to 36.8% (95% CI: 36.0%, 37.5%) in Chinese participants. Results were similar in American participants. Combined use of weight/height3 and waist-to-height ratio did not change the classification accuracy.Conclusions and relevanceTri-ponderal mass index (TMI) performed superior to BMI z scores and similar to BMI percentiles in Chinese and American participants. TMI is stable in adolescents, and could be a more efficient indicator for screening obesity-related cardio-metabolic risks in routine health screening compared with BMI.

Abstract Background: Parental myopia is an important risk factor for myopia in Chinese children and adolescents. This study aimed to assess the influence of parental myopia and the severity of myopia on offspring and to evaluate whether adopting healthy lifestyles can mitigate the effects of parental myopia on offspring. Methods: This cross-sectional study analyzed data from children and adolescents aged 6–17 years with complete vision assessments and parental history of myopia from six provinces in China during 2013–2014. Parental demographic information, children’s outdoor activity time, sleep time, and sedentary time were collected via questionnaire. Parental myopia was classified as no myopia, paternal myopia, maternal myopia, and both. The offspring were categorized into 10 groups based on parental myopia prescription. Associations of the above factors with myopia in children and adolescents were evaluated by logistic regression analysis. Results: Among 40,864 children and adolescents (50.3% boys and 49.7% girls), 22,537 (55.2%) were diagnosed with myopia. In comparison to offspring devoid of parental myopia, children with one parent affected by myopia exhibited odds ratio (OR) of 1.75 (95% confidence interval [CI]: 1.62–1.88) for myopia, while those with both parents affected showed OR of 2.27 (95% CI: 2.02–2.55) after adjusted for lifestyle factors. The likelihood of myopia in offspring increased with increasing severity of parental myopia, with a 3.08-fold increase in risk observed when both parents presented high myopia. Nonetheless, children adhering to two or more healthy lifestyle factors demonstrated a diminished risk of myopia compared with those with fewer than two lifestyle factors, especially among offspring of non-myopic or mildly myopic parents. Conclusions: Parental myopia has a dose-dependent association with their offspring. Healthy lifestyles may reduce the impact of parental factors on myopia in offspring. The observed associations suggest that although the genetic burden of parental myopia cannot be ignored, healthy lifestyles and nurturing are also very important.

China and the United States (US) ranked first and third in terms of new liver cancer cases and deaths globally in 2020. Therefore, a comprehensive assessment of trends in the incidence of primary liver cancer with four major etiological factors between China and the US during the past 30 years with age-period-cohort (APC) analyses is warranted. Data were obtained from the Global Burden of Disease 2019, and period/cohort relative risks were estimated by APC modeling from 1990 to 2019. In 2019, there were 211,000 new liver cancer cases in China and 28,000 in the US, accounting for 39.4% and 5.2% of global liver cancer cases, respectively. For China, the age-standardized incidence rate (ASIR) consecutively decreased before 2005 but increased slightly since then, whereas the ASIR continuously increased in the US. Among the four etiological factors of liver cancer, the fastest reduction in incidence was observed in hepatitis B virus-related liver cancer among Chinese women, and the fastest increase was in nonalcoholic steatosis hepatitis (NASH)-related liver cancer among American men. The greatest reduction in the incidence of liver cancer was observed at the age of 53 years in Chinese men (-5.2%/year) and 33 years in Chinese women (-6.6%/year), while it peaked at 58 years old in both American men and women (4.5%/year vs . 2.8%/year). Furthermore, the period risks of alcohol- and NASH-related liver cancer among Chinese men have been elevated since 2013. Simultaneously, leveled- off period risks were observed in hepatitis C viral-related liver cancer in both American men and women. Currently, both viral and lifestyle factors have been and will continue to play an important role in the time trends of liver cancer in both countries. More tailored and efficient preventive strategies should be designed to target both viral and lifestyle factors to prevent and control liver cancer.

Purpose Diet plays a fundamental role in promoting resilience against stress-related disorders. We aimed to examine the overall and sex-specific association between food groups and perceived stress in adults. Methods We analyzed the prospective data of 7,434 adults who completed both the 2011 and 2015 surveys of the China Health and Nutrition Survey (CHNS). The Diet Quality Questionnaire (DQQ) was used to code all the food items of 2011 dietary intake into 29 food groups, and perceived stress in 2015 was measured using a 14-item perceived stress scale (PSS-14). Univariate analysis and logistic regression models were used to examine the relationship between food groups and perceived stress. Results People who perceived a higher level of stress (PSS-14 total score > 25) made up 41.5% and 45.1% of the male and female groups, respectively (χ 2  = 9.605, p  = 0.002). Individuals with increased intake of food groups such as legumes, other vegetables, other fruits, yogurt, poultry, fish & seafood, fluid milk, and fruit juice were less likely to experience a higher level of psychological stress (OR range: 0.544–0.892, p  < 0.05). Additionally, we found sex-specific associations between food groups and perceived stress. The difference in the proportion of food groups, such as fluid milk and fish & seafood, between the two stress groups in men was statistically significant ( p  < 0.025). In the female group, the distribution of eight food groups, like legumes and nuts & seeds, between the two stress groups was statistically significant ( p  < 0.025). Conclusion This study indicated that food groups were differentially associated with perceived stress.

HIV/AIDS has become the leading cause of death by infectious disease in China since 2009. However, the trend of gender disparities in HIV/AIDS has not been reported in China since 1990. Our study aimed to explore the secular trend of HIV/AIDS mortality in China from 1990 to 2016 and to identify its gender disparities over the past 27 years. The mortality data of HIV/AIDS were obtained from the Global Burden of Disease Study 2016 (GBD 2016). Logistic regression was used to estimate the prevalence odds ratio (POR) of gender for HIV/AIDS mortality in different surveys. The standardized mortality of HIV/AIDS in China rose dramatically from 0.33 per 100,000 people in 1990 to 2.50 per 100,000 people in 2016. The rate of HIV/AIDS mortality increased more quickly in men than in women, and the sex gap of mortality of HIV/AIDS widened. By 2016, the HIV/AIDS mortality in men was 3 times that in women and was 5.74 times that in women within the 75- to 79-year-old age group. The mortality of HIV/AIDS in China is increasing, with a widening gender disparity. It is critical for policymakers to develop policies to eliminate these disparities and to ensure that everyone can live a long life in full health.

Background To explore the associations between the Chinese famine exposure in early life and the dyslipidemia in adulthood. Methods We selected 2752 participants from the baseline survey of China Health and Retirement Longitudinal Study (CHARLS) 2011–2012 to evaluate the associations of early life the Chinese famine exposure with risk of dyslipidemia in adulthood. Dyslipidemia was defined as TC (Total Cholesterol): HDL-C (High-Density Lipoprotein Cholesterol) ratio ≥ 5.0 or use cholesterol lowering drugs. Famine exposure cohorts were categorized by birthdates of participants. Binary logistics regression model was used to examine the associations of early-life famine exposure with the risk of dyslipidemia. Results The dyslipidemia prevalence of the non-exposed cohort, fetal stage-, infant stage-, and preschool stage-exposed cohorts in adulthood was 15.7%, 23.1%, 22.0%, and 18.6%, respectively. Early-life exposure to the Chinese famine significantly increased LDL cholesterol concentrations in adulthood after adjusted for age. The risks of dyslipidemia in fetal (OR = 1.58; 95% CI: 1.23–2.03; P  < 0.001) and infant (OR = 1.52; 95% CI: 1.15–2.00; P  = 0.003) stage-exposed cohorts were significantly higher than the non-exposed cohort after adjusted for gender and current family economic status. Following gender stratification, we found that fetal (OR = 1.80; 95% CI: 1.26–2.57; P  = 0.001), infant (OR = 1.75; 95% CI: 1.17–2.62; P  = 0.006), and preschool (OR = 1.63; 95% CI: 1.10–2.42; P  = 0.015) -stage exposure to severe famine aggravated the risk of dyslipidemia in female adults. However, the similar association was not observed for male adults. Conclusions Early-life exposure to severe Chinese famine could link with the higher dyslipidemia risk in female adulthood, but not in male adulthood. This gender-specific effect might be associated with the hypothesis that parents in China prefer boys to girls traditionally or survivors’ bias.

The aims of this study were to explore whether DNA methylation at INSR and IGF2 mediated the association of prenatal exposure to the Chinese great famine with adulthood waist circumference (WC) and BMI. A total of 235 subjects were selected into the present study from severely affected province and a neighbor province with less severely affected famine in China through multi-stage clustered random sampling. DNA methylation at the INSR and IGF2 gene promoter regions was detected by the Sequenom’s MassARRAY system. The “mediation” package of R was used to evaluate the mediation effect of DNA methylation on the association between prenatal exposure to the famine and adult WC and BMI. The results showed that prenatal famine exposure was significantly associated with higher overall methylation level of the INSR gene ( d  = 3.6%; 95% CI 1.2–6.0; P  = 0.027) and larger adulthood WC ( d  = 2.72 cm; 95% CI 0.20–5.24; P  = 0.034). Furthermore, famine significantly increased methylation levels at four CpG sites. Methylation of the CpG7 site mediated 32.0% (95% CI 5.0–100.0%, P  = 0.029) of the association between prenatal exposure to the Chinese great famine and adulthood WC. In conclusion, Epigenetic changes to the INSR might mediate the adverse effect of prenatal famine exposure on WC in adulthood.