Xiangyu Chen

Objectives: This study aimed to examine the cross-sectional associations between serum folate concentrations and four lipid abnormality subtypes among community-dwelling adults in Zhejiang Province, China. Methods: This population-based cross-sectional study included 3254 adults from Zhejiang Province, China. Serum folate concentrations were analyzed both as quartiles and per 1-standard deviation (SD) increments. Multivariable logistic regression models were used to evaluate the associations of serum folate with hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C). Restricted cubic spline (RCS) regression models were further applied to assess dose–response patterns. Additional RCS analyses using continuous lipid parameters were also performed. False discovery rate (FDR) correction, exploratory subgroup analyses, and sensitivity analyses were additionally conducted. Results: The prevalences of hypercholesterolemia, hypertriglyceridemia, high LDL-C, and low HDL-C were 7.87%, 17.12%, 4.30%, and 4.46%, respectively. In the fully adjusted model, each 1-SD increment in serum folate was associated with lower odds of hypertriglyceridemia (OR = 0.82, 95% CI: 0.73–0.92) and low HDL-C (OR = 0.63, 95% CI: 0.49–0.81). Compared with the lowest quartile, participants in the highest serum folate quartile had lower odds of hypertriglyceridemia (OR = 0.62, 95% CI: 0.46–0.82) and low HDL-C (OR = 0.38, 95% CI: 0.22–0.64), with significant trends across quartiles (both p for trend < 0.001). No significant associations were observed for hypercholesterolemia or high LDL-C. These findings remained significant after FDR correction. RCS analyses suggested an overall inverse association between serum folate and hypertriglyceridemia, with no evidence of nonlinearity (p for overall = 0.001; p for nonlinearity = 0.212), whereas the association with low HDL-C showed evidence of nonlinearity (p for overall < 0.001; p for nonlinearity = 0.009). Additional RCS analyses using continuous lipid parameters showed broadly consistent findings for TG and HDL-C. Exploratory subgroup and sensitivity analyses showed generally similar results. Conclusions: Higher serum folate concentrations were cross-sectionally associated with lower odds of hypertriglyceridemia and low HDL-C among community-dwelling adults in Zhejiang Province, China, whereas no significant associations were observed for hypercholesterolemia or high LDL-C. Further prospective cohort studies are warranted to verify these cross-sectional findings and to explore underlying mechanisms.

Objectives: We aimed to examine the association between bubble tea consumption and anxiety symptoms among adolescents in Eastern China and to explore the potential role of sleep disturbance in the observed association between bubble tea consumption and anxiety symptoms. Methods: This study utilized cross-sectional baseline data from the Zhejiang Childhood Behavior and Health Cohort. Bubble tea consumption frequency was categorized as 0, 1–2, and ≥3 days per week. Anxiety symptoms were assessed using the Generalized Anxiety Disorder—7 (GAD-7) scale, while sleep disturbance was measured through self-reported items. Associations between bubble tea consumption and anxiety symptoms were examined using multivariable logistic regression models, and dose–response relationships were evaluated with restricted cubic spline (RCS) models. Subgroup analyses stratified by age, sex, school type, residence, and body mass index (BMI) were conducted to assess the consistency of the associations. An exploratory mediation analysis with bootstrap confidence intervals was performed to evaluate the indirect association through sleep disturbance. Sensitivity analyses using a stricter definition of anxiety symptoms (GAD-7 ≥ 10) were conducted to assess robustness. Results: A total of 11,847 adolescents aged 12–18 years were included, of whom 32.03% met the GAD-7 threshold for any anxiety symptoms (GAD-7 ≥ 5, including mild symptoms). Compared with non-consumers, adolescents consuming bubble tea 1–2 days per week had higher odds of anxiety (OR = 1.12, 95% CI: 1.02–1.22), while those consuming bubble tea ≥3 days per week had substantially higher odds (OR = 1.53, 95% CI: 1.30–1.80). Each additional day of bubble tea consumption per week was associated with 10% higher odds of anxiety (OR = 1.10, 95% CI: 1.06–1.14). RCS analysis demonstrated a significant positive linear association between bubble tea consumption and anxiety (p for non-linearity > 0.05). Associations were consistent across age, sex, school type, residence, and BMI categories (all p for interaction > 0.05). Sensitivity analyses yielded similar results. Exploratory mediation analysis suggested that sleep disturbance may be statistically related to a portion of the observed association between bubble tea consumption and anxiety symptoms. Conclusions: Higher frequency of bubble tea consumption was associated with greater odds of anxiety symptoms among adolescents in a dose–response pattern. Sleep disturbance may statistically explain part of the association. These findings should be considered hypothesis-generating and require confirmation in prospective longitudinal studies.

Background/Objectives: Several studies have suggested a positive association between salt intake and obesity, yet longitudinal evidence is limited. We aimed to investigate the longitudinal association between salt intake and multiple adiposity indicators. Methods: We used longitudinal data from a cluster-randomized controlled trial conducted in Zhejiang Province, China, including 7372 adults with 12,800 observations. Twenty-four-hour salt intake was estimated using spot urine samples. Adiposity was assessed using body mass index (BMI), body roundness index (BRI), body fat mass, overweight and central obesity. Associations between salt intake and adiposity were evaluated using generalized linear mixed-effects models. Mediation analyses were conducted to quantify the proportion of associations mediated by body fat mass. Results: Mean baseline 24 h salt intake was 9.88 g/d. Compared with participants in the lowest quartile of salt intake (1 g/d) were associated with decreases in BMI [−0.21 kg/m² (−0.33, −0.09)], BRI [−0.04 (−0.09, 0.00)], and body fat mass [−0.14 kg (−0.36, 0.07)]. Associations were stronger among women and adults aged < 40 years (p-values < 0.05). Body fat mass mediated 56.93%–84.73% of the associations. Conclusions: This study indicates a dose–response association between salt intake and obesity risk, partly mediated by increased body fat mass. The findings suggest that dietary salt may influence cardiovascular risk through adiposity-related pathways.

Background: Although B vitamins are implicated in cardiovascular regulation, the associations between serum thiamine (vitamin B1) and blood pressure (BP) remain unclear, particularly among women who are at high risk for hypertension-related complications. This study aimed to investigate relationships between serum thiamine levels and BP outcomes among middle-aged and elderly women in eastern China. Methods: A community-based cross-sectional study was conducted among 2015 women aged 45–69 years in Zhejiang Province, China. Serum thiamine levels were quantified using liquid chromatography tandem mass spectrometry (LC-MS/MS). Hypertension was defined as measured BP ≥ 140/90 mmHg, or current use of antihypertensive medications. Multivariate logistic and linear regression models were used to assess associations of thiamine with hypertension prevalence and BP levels, respectively. Dose–response relationships were evaluated using restricted cubic splines (RCSs). Results: Higher thiamine levels were significantly associated with reduced hypertension prevalence (adjusted OR per SD increase: 0.87; 95%CI: 0.77, 0.97), with RCSs confirming linear dose–response (p-overall < 0.05, p-nonlinearity > 0.05). Compared with the lowest tertile, participants in the highest thiamine tertile had a 25% lower hypertension risk. Thiamine levels also showed negative associations with systolic BP (adjusted coef: −1.51 mmHg per SD; 95% CI: −2.33, −0.68), with the participants in the highest tertile showing a 3.94 mmHg reduction (95%CI: −5.97, −1.92). No significant relationship was found for diastolic BP. Conclusions: Serum thiamine is inversely associated with both hypertension prevalence and systolic BP in middle-aged and elderly women. This study supports the potential of serum thiamine as a modifiable biomarker in hypertension prevention strategies, particularly among aging women.

Objectives: The objective of this study was to examine the association between non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) and chronic kidney disease (CKD) in Chinese adults with type 2 diabetes mellitus (T2DM). Methods: This study originated from a survey carried out in Zhejiang Province, located in eastern China, between March and November 2018. To explore the relationship between NHHR and CKD, a multivariable logistic regression model was employed. The dose–response relationship was assessed using restricted cubic spline (RCS) analysis, while generalized additive models (GAMs) were applied to examine the associations between NHHR and urinary albumin-to-creatinine ratio (UACR) as well as estimated glomerular filtration rate (eGFR). Subgroup analyses were performed across various demographic and clinical categories to assess the consistency of the NHHR–CKD association. The optimal NHHR cutoff for CKD diagnosis, its predictive accuracy, and its comparison with its components and HbA1c were determined through receiver operating characteristic (ROC) curve analysis. Results: The study enrolled 1756 participants, including 485 individuals with CKD and 1271 without CKD. Multivariable logistic regression revealed a significant positive association between NHHR and CKD, with each standard deviation (SD) increase in NHHR linked to a 23% higher odds of CKD (OR = 1.23, 95% CI: 1.09–1.37) after adjusting for potential confounders. When comparing quartiles, the fully adjusted ORs for Q2, Q3, and Q4 were 1.29 (0.92–1.79), 1.31 (0.94–1.83), and 1.87 (1.34–2.60), respectively, relative to Q1 (p for trend < 0.01). RCS analysis confirmed a linear dose–response relationship between NHHR and CKD in both sexes (p for nonlinearity > 0.05). GAMs indicated a significant positive correlation between NHHR and UACR (ρ = 0.109, p < 0.001) but no significant association with eGFR (ρ = −0.016, p = 0.502). Subgroup analyses demonstrated consistent associations across most subgroups, except for the 18–44 years age group, the well-controlled glycemic group, and the non-alcohol drinking group (p > 0.05). ROC curve analysis identified an optimal NHHR cutoff of 3.48 for CKD prediction, with an area under the curve (AUC) of 0.606 (95% CI: 0.577–0.635). Notably, NHHR outperformed its individual components and HbA1c in predictive performance. Conclusions: This study revealed a linear link between higher NHHR levels and increased CKD prevalence in Chinese T2DM patients. NHHR may also serve as a potential complementary biomarker for early CKD detection, though further prospective studies are needed to confirm its predictive value and clinical utility in high-risk T2DM populations.

Background: Addressing high-salt diets in China through interventions can significantly reduce blood pressure (BP) and the associated health risks. Objective: This study aims to evaluate the effectiveness of a comprehensive salt reduction intervention implemented across counties in Zhejiang Province, focusing on system establishment, extensive publicity, and targeted population interventions. Methods: The Salt Reduction and Hypertension Prevention Project was initiated in Zhejiang Province. Cross-sectional surveys were conducted before the intervention and after. The research commenced in 2017 with a baseline survey involving 7512 participants from five counties. Four counties were randomly selected for the intervention, implementing a multifaceted salt reduction strategy, while one county served as a reference without any intervention. The primary outcomes measured were changes in BP and 24 h urinary sodium and potassium excretion. Results: Following the intervention, 24 h urinary potassium excretion experienced a significant increase, rising from 1441.3 (SD 681.9) to 1676.9 (SD 931.4) mg per day, p < 0.001. Utilizing a linear mixed-effects model, the adjusted net difference in urinary sodium changes was calculated to be 394.1 mg per day (95% CI, 133.2 to 655.0) (p = 0.003). There was a notable reduction in systolic blood pressure (SBP) from 131.2 (SD 19.2) to 129.8 mmHg (SD 18.0), and diastolic blood pressure (DBP) also decreased from 80.8 (SD 10.8) to 78.9 mmHg (SD 10.2), p < 0.001. The adjusted net differences for SBP and DBP between the intervention and reference groups were 1.3 (95%CI, 0.5 to 2.1) and 1.4 mmHg (95%CI, 0.9 to 2.0), respectively, p < 0.001. Conclusions: The findings indicate that a multi-sectoral approach, combined with extensive public awareness initiatives and precisely targeted interventions, can significantly increase urinary potassium excretion and reduce sodium and blood pressure.

Purpose: This study aimed to investigate the current status and associated factors of hand and oral hygiene behaviors among adolescent students in Zhejiang Province, Eastern China. Methods: This study utilized a cross-sectional survey conducted in Zhejiang Province between April and June 2022. Data were collected through a self-administered, structured questionnaire that assessed tooth brushing frequency, hand washing practices before meals, after toilet use, and hand washing with soap. Multivariate logistic regression was performed to identify associations between hygiene practices and socio-demographic factors. Results: The study included 26,101 adolescent students. Of these, 29.25% had poor oral hygiene practices, and the majority brushed their teeth twice per day (51.43%). Regarding hand hygiene, 78.06% exhibited poor hand hygiene before meals, 24.67% after toilet use, and 82.56% when using soap. Multivariate logistic regression analysis indicated that higher parental education and greater family income were linked to a reduced likelihood of poor oral and hand hygiene practices. Conversely, older age and parental marital status (divorced, widowed, or separated) were linked to an increased risk of both poor oral and hand hygiene practices. Additionally, girls and only children were less likely to exhibit poor oral hygiene but more likely to have poor hand hygiene. Conclusion: The prevalence of poor hand and oral hygiene practices among adolescent students in Zhejiang Province, Eastern China was very high. Several socio-demographic factors were identified to guide future targeted interventions aimed at improving hygiene practices among this population.

Objectives: This study aimed to investigate the relationship between the triglyceride–glucose (TyG) index, its combination with the body roundness index (BRI), and chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) based on a cross-sectional analysis conducted in Eastern China. Methods: The research originates from a cross-sectional study performed in Zhejiang Province, Eastern China, between March and November 2018. The TyG-BRI index was calculated based on triglyceride, fasting blood glucose, and the BRI. The correlation between the TyG-BRI index and the risk of CKD was assessed using a restricted cubic spline model. A multivariate logistic regression model was used to investigate the association between the TyG-BRI index and the risk of CKD. Receiver operating characteristic (ROC) analyses was used to evaluate the optimal cut-off and value of the TyG-BRI index for predicting CKD. Results: A total of 1756 T2DM participants were enrolled in this study. The TyG-BRI index was significantly higher in participants with CKD than in those without CKD. In the fully adjusted model, the odds ratios for CKD in the second, third, and fourth TyG-BRI quartiles were 0.93 (95% CI: 0.65–1.33), 1.33 (95% CI: 0.94–1.88), and 1.57 (95% CI: 1.10–2.25), respectively, compared to the first quartile. RCS analysis confirmed a linear dose–response relationship between the TyG-BRI index and CKD risk (all p for nonlinearity > 0.05). ROC curve analysis revealed that the TyG-BRI index had moderate predictive value for CKD, with an area under the curve of 0.626 (95% CI: 0.597–0.656, p < 0.001). The optimal cut-off value for the TyG-BRI index was 42.46, with a sensitivity of 68.2% and specificity of 52.2%. Conclusions: The TyG-BRI index was positively associated with the risk of CKD in a T2DM population, demonstrating a dose–response relationship and moderate predictive value. It may serve as a valuable tool for identifying high-risk individuals and informing targeted interventions to prevent or delay CKD progression in this population.

Background: Research into the pivotal role of potassium in chronic diseases and their comorbidities remains scarce. Our aim is to elucidate the relationship between potassium and chronic diseases, including comorbid conditions, and to provide evidence-based recommendations for potassium intake in patients. Methods: This study is anchored in a representative, population-based survey conducted in Zhejiang Province, China, in 2017, encompassing participants aged 18 to 69 years. Data collection included questionnaire responses, physical measurements, and biological samples, obtained through a multistage cluster random sampling method. A subset of 1496 participants provided complete 24 h urine samples. Results: The median age of the participants was 48.0 years (interquartile range [IQR] 24.0), with 51.1% being female, and hypertension was identified in more than one third (35.6%) of the participants. The prevalence of diabetes was approximately 9.0%, dyslipidemia was found in 34.2%, and microalbuminuria in 8.8%. The 24 h urinary excretion levels were 3613.3 mg/24 h (IQR 2161.7) for sodium and 1366.0 mg/24 h (IQR 824.9) for potassium, respectively. Potassium excretion exhibited an inverse relationship with blood pressure. Furthermore, a positive correlation was observed between potassium excretion and high-density lipoprotein cholesterol (HDL-C) levels, with an elevation of 0.03 mmol/L (95% confidence interval [CI] 0.00 to 0.05). In binary logistic regression analysis, individuals in the fourth quartile of potassium excretion (Q4) exhibited an odds ratio (OR) of 0.56 (95% CI 0.36–0.87) for hypertension compared to those in the first quartile (Q1). Urinary potassium excretion was inversely associated with low HDL-C levels, with Q4 individuals having 0.62 times the odds of having low HDL-C levels (OR, 0.62; 95% CI 0.39–1.00) compared to Q1. Conclusions: Potassium excretion demonstrated a direct negative correlation with certain comorbidities. This study underscores the pivotal role of potassium in the management of chronic diseases and associated comorbidities, thereby highlighting the significance of potassium in both public health initiatives and clinical practice.

In China, a major source of sodium is salt added during cooking. In this context, use of a salt-restriction spoon (SRS) has been promoted in public health campaigns and by health care providers. To describe use of and factors associated with SRS use, knowledge of correct use, and actual correct use. This study is a population-based, representative survey of 7512 residents, aged 18 to 69 years, of China’s Zhejiang Province. The survey, which was conducted in 2017 using a multistage random sampling strategy, collected demographic information, SRS use, and physical measurements; a 24-h urine collection was obtained from 1,496 of the participants. The mean age of the participants was 44.8 years, 50.1% were females, and over 1/3 (35.3%) were classified as hypertensive. Mean 24-h urinary sodium and potassium excretions were 167.3(72.2) mmol/24 h and 38.2(18.2) mmol/24 h, respectively. Only 12.0% (899/7512) of participants once used or were currently using SRS; of the 899 users, 73.4% knew how to use the SRS correctly, and just 46.5% actually used it correctly. SRS use was more commonly associated with behavioral factors rather than socio-demographic factors. Initiation of SRS use by health care providers was associated with correct technical knowledge of SRS. Lower sodium-to-potassium ratio was associated with SRS use, while SRS use was not associated with urinary sodium and potassium excretion. Use of SRS was uncommon in Zhejiang Province of China. Given that a common source of sodium in China is salt added during cooking, use of SRS is an appealing strategy, ideally as part of a multi-component campaign.