Qiang Zhang

Objective: The development of myopia is subject to individual genetic predisposition and environmental risk exposures. This study aims to investigate the trajectories and predictors of spherical equivalent (SE) among multiethnic school-aged children in Southwest China. Methods: The school-based cohort study was conducted from October 2020 to March 2023 in Yunnan province, Southwest China. Ocular examinations and questionnaire surveys were administered at each visit. A total of 679 students with complete records from all three visits were included in the final analyses. Group-based trajectory modelling was used to identify SE trajectories. Associations between the trajectory groups and baseline predictors were assessed using multinomial logistic regression. Results: We identified two distinct trajectory groups of SE in grades 2–3: slow progressive (84.4% of students) and rapid progressive (15.6%). Multivariate analysis indicated that children with myopic parents and those who often stayed in the classrooms during recess were more likely to belong to the rapid progressive group. By contrast, three trajectory groups of SE were identified in grade 7: slow progressive (52.3% of students), moderate initial and rapid progressive (33%) and low initial and rapid progressive (14.7%). In multivariate models, being a girl, having myopic parents, using mobile screens for more than 0.5 hours per day and often staying in the classrooms during recess were predictors of the progressive groups. Moreover, there were no significant differences in SE trajectories between Han and ethnic groups. Conclusion: There is heterogeneity in the developmental trajectories of SE, for both primary and secondary school students. Tailored intervention strategies based on the predictors of the SE trajectories should be under special consideration.

Objective To investigate the relationship between sleep duration and myopia among primary school students in minority regions of Southwest China. Methods The school-based, cross-sectional study was conducted from October 2020 to January 2021. All participants underwent a comprehensive ocular examination and completed a questionnaire on demographic characteristics, ophthalmological history and major environmental factors for myopia. Spherical equivalent (SE) and ocular biometric parameters were measured after cycloplegia, with myopia being defined as SE ≤−0.5 D (Diopter). Multivariate regression models were used to examine the association of sleep duration with myopia, SE and axial length (AL). Results A total of 857 students from grades 2 to 4 were included in the analysis, of which 63.6% were myopic and 62.0% belonged to ethnic minorities. Boys had a slightly higher prevalence of myopia compared with girls (66.7% vs 60.6%, p=0.06). Myopic students had longer AL, deeper anterior chamber depth and thinner central corneal thickness compared with non-myopic students (all pConclusion This cross-sectional study did not find a significant association between sleep duration and myopia. However, it suggests that 8–9 hours of sleep per day may have a protective effect on SE progression and AL elongation in girls. Future studies with objectively measured sleep duration are needed to validate the findings.

Background: Although social capital has been linked to dietary intake particularly in disadvantaged populations, little is known about the mechanisms. This study aimed to investigate whether social support (SS) and nutrition knowledge (NK) mediate the association between social capital and healthy eating habits.Methods: A probability sample of two ethnic minority groups in Yunnan Province, Southwest China were included (n = 1,033, mean age 47.5 ± 14.7 years). Bonding and bridging social capital (BOC and BRC) were assessed with the Personal Social Capital Scale (PSCS-16). Dietary data were evaluated with the Chinese Healthy Eating Index (CHEI), a measure of diet quality which reflects adherence to the Chinese Dietary Guidelines. NK and SS were measured with a validated questionnaire and scale, respectively. Structural Equation Modeling was used to calculate the direct, indirect and total effects of social capital on CHEI scores.Results: The mean score of CHEI was 57.4 ± 9.8, which was significantly lower in men and older people. Low adherence to dietary guidelines were to observed in the consumption of dairy, beans, nuts, animal-source food vegetables and fruits. BOC and BRC were positively associated with CHEI score (β = 0.37 and 0.38, all p < 0.05). Social support and nutrition knowledge mediated 45.9 and 39.5% of the total effect of social capital on CHEI score, respectively.Conclusion: Social capital appears to enhance adherence to dietary guidelines by improving nutrition knowledge and social support. Nutrition promotion programs therefore should consider incorporating strategies that foster social capital development, particularly in disadvantaged populations.

To analyze the relationship between food intake and chronic diseases of Dulong minority residents living in Yunnan Province. 460 Dulong minority residents 6-80-year-old among 304 families(male 191, female 269, children and adolescents aged 6-17 years old 56, aged 18-44 years old 229, aged 45-59 years old 123, aged 60-80 years old 52)in Gongshan County in Yunnan Province were selected with Stratified multistage cluster sampling method. To apply the method of food frequency questionnaire and questionnaire survey obtain the condition of dietary structure and overweight or obesity, diabetes and dyslipidemia among Dulong minority. Non-conditional Logistic regression analysis was utilized to analyze the correlation between food intake and chronic diseases. The prevalence of overweight or obesity, hypertension, diabetes and dyslipidemia were respectively 20.4%, 19.6%, 32.4% and 50.4% in 2016. Marital status and consumption of melons vegetables(OR=0.540, 95%CI 0.306-0.954), benevolence fruit kind fruit(OR=0.348, 95%CI 0.171-0.706) and low fat milk powder(OR=5.267, 95%CI 1.266-21.911) in the past 12 months were associated with hypertension among the Dulong minority population. For the Dulong minority residents, sex, eaten deep-fried dough stick(OR=0.403, 95%CI 0.182-0.894) in the past 12 months, solanaceous vegetables(OR=0.478, 95%CI 0.275-0.832) and whole milk powder(OR=2.090, 95%CI 1.372-3.184) have something to do with diabetes. Occupation, consumption of beancurd and bamboo vegetables(OR=4.753, 95%CI 1.079-20.937), solanaceous vegetables(OR=2.842, 95%CI 1.175-6.871) and edible fungi(OR=1.794, 95%CI 1.116-2.883) over the past 12 months were linked to the prevalence of overweight. Consumption of fresh legumes(OR=1.991, 95%CI 1.130-3.507), whole milk powder(OR=2.342, 95%CI 1.535-3.575), cooked poultry meat(OR=2.092, 95%CI 1.147-3.815), grass carp(OR=0.580, 95% CI 0.379-0.888)and fresh eggs(OR=0.432, 95%CI 0.196-0.950) and in the past 12 months were associated with dyslipidemia among the Dulong minority residents. The prevalence of overweight/obesity was mainly related to occupation, consumption of vegetables and products(solanaceous vegetables, edible fungi), and hypertension was mainly related to Marital status, and the intake of melons vegetables, benevolence fruit kind fruit, low fat milk powder), and diabetes was mainly related to sex, deep-fried dough stick, solanaceous vegetables and whole milk powder, and dyslipidemia was mainly related to Marital status, fresh legumes, whole milk powder, cooked poultry meat, grass carp, and fresh eggs for the Dulong nationality residents aged 6-80 years old in Gongshan County, Yunnan Province.

To analyzing the malnutrition status and influencing factors of children under 5 years in Yunnan Province. Multi-stage stratified sampling used in the national survey was performed. The subjects of the study were 2869 children under 5 years, selected from 13 counties(cities) in Yunnan Province from 2016 to 2017. The contents of the investigation included questionnaire survey and anthropometric measurement. Z-scores were calculated according to WHO growth standards by WHO Anthro V3.2.2 software. Non conditional Logistic regression model was used to analyze the multiple factors. SPSS 20.0 statistical software was used to calculate and analyze the malnutrition rate of children. A total of 2869 children under 5 years old were investigated in Yunnan Province, including 1433 boys(49.95%) and 1436 girls(50.05%). The prevalence of stunting, underweight and wasting of children under 5 years old were 3.46%, 6.37% and 3.42%. Logistic multifactor regression analysis showed that low birth weight(OR=4.368, 95% CI 2.057-9.275), rural area(OR=1.931, 95% CI 1.076-3.462), household use of unsanitary toilets(OR=1.688, 95% CI 1.022-2.790), children without supplemental food(OR=2.000, 95% CI 1.130-3.542) were the most important factors making the child more likely to become malnutrition in 6-23 month age group. Asking children for advice on food selection or cooking(OR=3.570, 95%CI 1.249-10.204) was the most important factors making the child more likely to become malnutrition in 6-23 month age group. The nutritional status of children under 5 years old in Yunnan Province has been improved, but the prevalence of malnutrition is still high.

Different dietary patterns and the risks of hypertension in various diet exposures among multi-ethnic population in southwest China remain extremely scarce. The aim of this study is to identify dietary patterns and explore the association between dietary patterns and the risk of hypertension among Han and multi-ethnic population in southwest China. A representative sample of 3591 participants of Han, and multi-ethnic population were recruited by stratified cluster sampling in Diqing of Yunnan Province, southwest China from September 2012 to January 2013. Participants who were under 18 years old or who could not clearly answer the questions and those who used the anti-hypertensive medication were excluded from this survey. All participants reported their dietary intakes using validated food frequency questionnaires (FFQ), and their blood pressures were measured by standardized procedures. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. Dietary patterns were identified by factor analysis with principal component. Logistic regression was used to explore the association between dietary patterns and hypertension. The overall prevalence of hypertension was 30.5% among Han and multi-ethnic population in Diqing, Yunnan Province. Three dietary patterns were identified in this study, defined as ‘Grassland healthy’, ‘Tuber and meat’, and ‘Fruit and vegetable’. Participants in the 5th quintile of the three dietary patterns were at a lower risk of hypertension compared with those in the 1st quintile. The odds ratio (OR) for the 5th quintile of ‘Grassland healthy’ pattern, ‘Tuber and meat’ and ‘Fruit and vegetable’ was 0.693 (95% CI: 0.537–0.893, p = 0.005), 0.678 (95% CI: 0.530–0.868, p = 0.002), 0.759 (95% CI: 0.593–0.970, p = 0.028), respectively. After further adjustment of participants’ age, the negative association between the ‘Grassland healthy’ pattern and the prevalence of hypertension persisted (OR = 0.703, 95% CI: 0.535–0.924, p = 0.012). However, the significant associations between the other two dietary patterns and hypertension disappeared. The ‘Grassland healthy’ dietary pattern is associated with lower risk of hypertension, whereas there is no significant associations between the other two dietary patterns and hypertension among Han and multi-ethnic population in Diqing of Yunnan province, southwest China.

Objective: This study aims to understand the age patterns of smoking initiation during adolescence and young adulthood in South-West China, where the prevalence of tobacco use is reported as the highest in the country. Design: A cross-sectional study. Setting: The data were derived from the China National Nutrition and Health Survey in Yunnan Province, South-West China (2010–2012). Participants: A total of 4801 participants aged 15–65 years were included. Primary outcome measures: A survival model was used to estimate the hazard of smoking initiation by age and log-rank test was used to compare the hazard curves across subgroups (men/women, urban/rural, Han Chinese/ethnic minority). Results: The prevalence of current smoking among men and women were 60.4% (95% CI 58.2% to 62.6%) and 5.1% (95% CI 4.3% to 5.9%), respectively. Smoking was more prevalent among men and women of lower education and less income, as well as rural and ethnic minority women. Among the current smokers, cigarette (80.7%) was the most commonly used tobacco product, followed by waterpipe (10.8%) and pipe tobacco (8.5%). The hazards of smoking initiation were low for both men and women before the age of 15 years (1% for men and 0.05% for women); and the hazards increased quickly from age 15 years and peaked at 19years (21.5% for men and 1.0% for women). Rural and ethnic minority women were at higher risk of smoking initiation than their counterparts between 15 years and 19 years of age (χ ² =44.8, p2 =165.2, p<0.01) and no such difference was found in men. Conclusions: Findings of this study underscore the importance to implement tobacco prevention interventions among older teens and young adults in South-West China, especially for rural and ethnic minority women.

A balanced diet is essential to achieve and maintain good health. In this study, we assessed diet quality of middle aged and elderly people based on Chinese Diet Balance Index-07 (DBI-07) and explored the associations between DBI-07 and anemia. Data analyzed for this study was from the 2010–2012 National Nutrition and Health Survey in Yunnan province, southwest China (n = 738, aged 50–77 years). Dietary recalls over there consecutive days were done in a face-to-face interview. The scores of DBI-07 for each component and three DBI-07 indicators ((Lower Bound Score (LBS), Higher Bound Score (HBS), Diet Quality Distance (DQD)) were calculated according to compliance with the Dietary Guidelines for Chinese residents. Hemoglobin (Hb) concentration was determined using the cyanmethemoglobin method. Univariate and multivariate linear regression models were used to explore the associations between DBI-07 indicators and anemia, as well as scores of DBI-07 components and Hb level. The sample included 336 men and 402 women. Inadequate intakes of vegetables, fruits, dairy, soybean, eggs, fish and excessive intakes of cereals, meat, cooking oil, salt were both common. 91.3% of the participants had moderate or high levels of inadequate food intake, while 37.7% had moderate or high levels of excessive food intake. The mean Hb was 14.2 ± 1.7 g/dL, with a prevalence of anemia of 13.0%. Subjects with high LBS and DQD were more likely to be anemic (all p < 0.05). After adjustment for potential confounders, there were positive correlations between Hb level and the intakes of vegetables and soybean (β_vegetables = 1.04, p < 0.01; β_soybean = 0.82, p = 0.04). In conclusion, dietary imbalance and anemia are common in middle aged and elderly population in southwest China and inadequate intakes of vegetables and soybean may increase the risk of anemia.

With rapid urbanization in the past decades, diet diversity continues to increase in China. The present cross-sectional study aims to explore the association between dietary diversity and nutritional status among adults in southwest China. This study used data from 2011–2012 National Nutritional Survey in Yunnan Province, southwest China (N = 1105).Data of three consecutive 24-hour dietary recalls were used to calculate dietary diversity scores (DDS) and nutrient adequacy ratio (NAR). Body mass index and waist circumference were used to determine nutritional status. Surveylogistic procedure of SAS 9.2 software was used to examine the association between DDS and obesity by estimating odds ratio (OR) and 95% confidence intervals (CI). The mean DDS was 5.2 (SD 1.1) out of nine points. Being female, younger age, belonging to Han ethnicity, having higher educational level and household income were positively associated with DDS (all P<0.05). As DDS increased, consumption also increased in most food groups except grains and vegetables. People with medium and high DDS (DDS = 5 and DDS ≥6, respectively) ingested more energy than the recommended quantity(NAR = 1.1 and 1.2, respectively). However, the intakes of Calcium and Vitamin A were seriously inadequate even for people with high DDS (NAR≤0.5). With potential confounders adjusted, people with medium and high DDS were at higher risk of general and central obesity than people with DDS ≤4 (OR = 1.4–1.9, P<0.01). Our data indicated that high DDS was associated with excessive energy intake and obesity among adults in southwest China. Although dietary diversity is widely recommended, public health messages should give less emphasis on dietary diversity.

Dietary patterns represent a broader picture of food consumption, and are better correlated with a variety of health outcomes. However, few studies have been conducted to explore the associations between dietary patterns and obesity in Southwest China. Data from the 2010–2012 National Nutrition Survey in the province of Yunnan, Southwest China, were analyzed (n = 1604, aged 18–80 years). Dietary data were collected using the 24 h dietary recall over three consecutive days. Height, weight, and waist circumference were measured following standard methods. Exploratory factor analysis was used to identify dietary patterns. Logistic regression was used to explore the association between dietary patterns and obesity. Three distinct dietary patterns were identified, which were labeled as traditional, modern, and tuber according to their key components. With potential confounders adjusted, adults in the highest quartile of the modern pattern were at higher risk of general and central obesity (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.15–3.48; OR 2.01, 95% CI 1.37–2.93). In contrast, adults in the highest quartile of the tuber pattern were at lower risk of general and central obesity (OR 0.34, 95% CI 0.15–0.61; OR 0.64, 95% CI 0.43–0.95) but at higher risk of underweight (OR 2.57, 95% CI 1.20–6.45). No significant association was found between the traditional pattern and obesity. Moreover, dietary pattern differences occurred due to the differences in socio-demographic characteristics. In conclusion, the modern dietary pattern was positively, and the tuber pattern negatively, associated with general and central obesity among adults in Southwest China.