A multi-stage stratified randomized cluster sampling was used to conduct a survey on nutrition knowledge among Chinese school-aged children 6 to 17 years old from 195 survey sites in 31 provinces(autonomous regions and municipalities directly under the central government) of China. The questionnaire was used to collect nutrition knowledge of school-aged children in China, and to analyze the shortcomings of nutrition knowledge among school-aged children, so as to provide a basis for the formulation of nutritional intervention policies for children and the evaluation of the effectiveness of the educational work.

OBJECTIVE:To evaluate and validate the nutrition knowledge questionnaire for Chinese school-aged children. METHODS:In September 2023, a convenience sampling method was used to select one primary school, one junior high school, and one senior high school respectively in Suqian City's Sucheng District of Jiangsu Province and Dayi County of Chengdu City in Sichuan Province for a questionnaire survey. The questionnaire's reliability(Cronbach's alpha, split-half reliability) and validity(face validity, structural validity) were evaluated using quantitative method. RESULTS:A total of 1017 participants took part in the survey, including 251 lower-grade primary school students(grades 1-3), 249 upper-grade primary school students(grade 4 and above), 262 junior high school students, and 255 senior high school students. Among them, 480(47.2%) were from urban areas, 473(46.5%) were male, and the mean age was(11.9±3.6) years. The Cronbach's α coefficients for the four versions of the questionnaire were 0.54, 0.76, 0.79 and 0.79, respectively. The Guttman split-half coefficients were 0.58, 0.63, 0.66 and 0.72, respectively. Validity analysis indicated that the investigators and teachers generally approved of the questionnaire design. In the confirmatory factor analysis, the chi-square/degrees of freedom(χ~2/df) ranged from 1.49 to 1.66, the root mean square error of approximation(RMSEA) ranged from 0.04 to 0.05, and the goodness-of-fit index(GFI) ranged from 0.88 to 0.92. The correlations between each dimension and the total score were significantly higher than the correlations between the dimensions themselves. CONCLUSION:The lower primary school version of the questionnaire requires further refinement. In contrast, the versions for upper primary, junior high, and senior high school demonstrate satisfactory validity and reliability with well-structured dimensions, making them appropriate for assessing nutrition knowledge and supporting related research among students in the corresponding educational stages.

OBJECTIVE:To analyze the knowledge level and influencing factors related to dietary recommendations for Chinese school-aged children in 2023 to 2024. METHODS:A multi-stage cluster random sampling was used to select 195 survey sites across the country, there were 126 802 children surveyed, with 90 240 children in upper elementary, middle and high school included in the analysis. The "Nutrition and Health Knowledge Questionnaire for School-Aged Children in China" comprises five dimension, scored out of 100 points; dietary recommendation-related knowledge was scored out of 28 points, and a score of 21 points or above was judged as acquiring relevant knowledge. Univariate and multi-variate Logistic regression models were used to analyze the factors influencing relevant knowledge level. RESULTS:The average score of dietary recommendation-related knowledge was 16.7±5.1, and the knowledge awareness rate was 22.5%. In elementary, middle and high schools, the correct rates of food groups in each level of the Dietary Pagoda(upper elementary grades: 38.0%-69.1%; middle school: 33.3%-63.7%; high school: 28.3%-59.9%) and nutritional breakfast combinations(upper elementary grades: 14.6%; middle school: 40.7%; high school: 43.7%) were low; in middle and high schools, the recommended daily intake of oil(middle school: 22.9%; high school: 20.8%), salt(middle school: 33.8%; high school: 34.1%) and sugar(middle school: 35.1%; high school: 39.7%) per person was also low. Multivariate analysis revealed that the knowledge of dietary recommendations was lower among children in rural(OR_(upper elementary)=0.683, OR_(middle school)=0.923, OR_(high school)=0.830), central(OR_(upper elementary)=0.645, OR_(middle school)=0.573, OR_(high school)=0.487) and western(OR_(upper elementary)=0.586, OR_(middle school)=0.480, OR_(high school)=0.444) areas compared to the counterparts; female(OR_(upper elementary)=1.226, OR_(middle school)=1.197, OR_(high school)=1.123) had a higher awareness rate compared to male. The awareness rate is higher among day students compared to boarders in elementary and middle schools(OR_(upper elementary)=1.485, OR_(middle school)=1.081); while the rate was lower among day students in high schools(OR=0.932). The awareness rate of children increased with mother's literacy, and the trend was statistically significant(P<0.001). CONCLUSION:The level of knowledge related to the dietary recommendations for Chinese school-aged children in 2023-2024 was low, especially in terms of the foods at each level of the Dietary Pagoda, breakfast combinations, and the recommended intake of oil, salt, and sugar, and the knowledge level of children in rural, central and western areas, and those whose mothers are less literate is even lower.

OBJECTIVE:To analyze the geographical distribution characteristics of the nutrition knowledge(NK) level among school-aged children in China. METHODS:Data were from the China Nutrition Knowledge Survey among school-aged children from 2023 to 2024. The survey was conducted using a multi-stage stratified cluster random sampling method at 195 survey points, covering all grades from primary to senior high school, with data from 90 240 students in senior primary, junior and senior high school grades ultimately analyzed. After applying complex weighting to the sample, the population's NK level and its geographical disparities were described. The NK scores were described using mean±standard error, and the NK awareness rate was described using rates and 95%CI. Differences in scores across regions were tested using a complex sampling design-based one-way linear regression model, and comparisons of the awareness rates were performed using a design-based Rao-Scott χ~2 test. RESULTS:Urban children had higher scores(70.4±0.5) and NK awareness rates(n=31 750, 44.0%) than rural children(score: 66.5±0.9, awareness rate 32.4%(n=5667)). The eastern region(71.5±0.8, 47.3%(n=16 823)) also outperformed the central(67.4±0.8, 36.2%(n=10 200)) and western(67.7±0.8, 34.0%(n=10 404)) regions. Among all areas, North China recorded the highest NK level(72.3±0.7, 49.8%(n=5882)), while Northwest region had the lowest(65.1±0.8, 27.0%(n=2784)). All these reigonal differences were statistically significant(P<0.01). Regarding specific knowledge points, the correct rate for identifying a balanced breakfast was the lowest among primary school students across all regions(urban 14.6%, rural 14.5%; eastern 14.6%, central 11.8%, western 17.2%). For junior high school students, knowledge about the expiration date and food safety had the lowest correct rate(urban 18.0%, rural 18.9%; eastern 17.6%, central 17.0%, western 21.0%). For senior high school students, knowledge about the recommended intake of cooking oil had the lowest correct rate in the western region(19.4%), while in other regions, knowledge about expiration date and food safety remained the weakest. CONCLUSION:Significant geographical disparities were observed in the NK levels of Chinese school-aged children. Urban children, as well as those from the eastern and northern regions, demonstrated significantly higher NK levels than their rural, central/western, and northwestern counterparts.

OBJECTIVE:To assess the level and distribution of weight management knowledge among Chinese school-aged children at different educational stages. METHODS:Based on data from the 2023-2024 China Nutrition and Health Knowledge Survey of school-aged children, which covered 195 survey sites across 31 provinces(autonomous regions and municipalities), a multistage stratified cluster sampling design was applied. A total of 90 240 students from upper primary(grades 4-6), junior high, and senior high schools were included. Weighted analyses were performed according to the complex sampling design, with weights derived from sampling and post-stratification weights. Standard errors were estimated using the Taylor linearization method. Group differences were assessed by t or Wald F tests based on the complex sampling design. RESULTS:The overall weighted correct response rate for weight management knowledge was 83.97%(95%CI 83.83%-84.10%). Female students scored significantly higher than male students(85.68% vs.82.49%, P<0.01). Senior high school students demonstrated the highest knowledge level(86.21%(95%CI 85.96%-86.45%)). Urban students performed better than rural students(85.44% vs.81.48%, P<0.01), and those in eastern regions scored higher(85.80%(95%CI 85.59%-86.00%)) than peers in central and western regions. Across knowledge domains, students showed higher mastery of "physical activity and sedentary behavior" and "dietary misconceptions"(weighted accuracy>88.00%), while "healthy food choices" was the weakest domain, particularly among upper primary and junior high students(70.15%(95%CI 69.75%-70.54%) and 70.75%(95%CI 70.29%-71.20%), respectively). Items such as "avoiding fried foods when eating out" and "making healthy dining-out choices" were common weak points across stages. CONCLUSION:Chinese school-aged children demonstrated generally good knowledge of weight management, but boys, rural students, and those in central and western regions had relatively lower mastery. Knowledge related to healthy food choices remained the weakest across all stages.

The decline in differentiation capacity during skeletal muscle (SkM) aging contributes to the deterioration of skeletal muscle function and impairs regenerative ability. Epicatechin gallate (ECG), a major functional component of catechins found in tea, has an unclear role in aging-related sarcopenia. In vivo experiments in 54-week-old C57BL/6J mice showed that ECG treatment improved exercise performance, muscle mass, and fiber morphology and downregulated the expression of the testosterone metabolic enzyme gene UGT2A3 in aged mice. In vitro experiments with Leydig cells (TM3) demonstrated that ECG upregulated the mRNA and protein expression levels of testosterone synthase genes, including StAR, P450scc, 3β-HSD, CYP17a1, and 17β-HSD. Network pharmacology analysis further suggested that ECG can influence testosterone secretion through the regulation of cytokines, thereby promoting skeletal muscle differentiation. These findings indicate that ECG enhances the differentiation of skeletal muscle cells by modulating testosterone levels, which helps alleviate age-related muscle function decline.

Excessive food intake is significantly contributing to the rising rates of obesity and overweight in China, creating substantial financial and environmental challenges for the healthcare system. This study employs a cost of illness method combined with environmentally extended input-output analysis to assess the carbon footprint associated with obesity and overweight within China's healthcare sector. In 2020, healthcare expenditures related to obesity and overweight reached approximately 324.7 billion Chinese Yuan (CNY), resulting in emissions of 31.5 Mt. CO(2)e, which accounted for around 4.5 % of the total greenhouse gas emissions from the national healthcare sector. These emissions nearly negate the progress made in reducing greenhouse gas emissions in China's service sectors. The carbon intensity of the healthcare sector related to obesity and overweight is higher than that of the general medical sector, emphasizing the urgent need for more targeted and effective intervention measures. This study represents an initial effort to quantify the healthcare carbon footprint related to obesity and overweight, providing crucial insights into the potential resource and environmental savings achievable by addressing these issues. It highlights the necessity of understanding of the impact correlated to overweight and obesity, offering valuable perspectives for tackling the global challenges of obesity and climate change.

OBJECTIVES:This study aimed to evaluate the effectiveness of educational health message and menu default options on a Meal Delivery App (MDA) in nudging consumers towards reduced-salt options in restaurants of China. STUDY DESIGN:We conducted a nudge-based intervention trial on an MDA named ELEME in China. METHODS:Along with a control group, five intervention groups were formed utilizing different combinations of the three nudging treatments, including setting up a salt submenu for "reduced salt" default, a salt submenu for "regular salt" default, and a conventional educational health message on the ordering page. We recruited 903 restaurants from cities across different geographic regions and assigned them into either the control group or one of the five intervention groups. RESULTS:After analyzing 870,942 meal orders, the results showed that the inclusion of a health message on the restaurants' ordering page was not effective to influence consumers to choose reduced-salt dishes (P > 0.1). A salt submenu that explicitly asked for consumers' preference for "reduced salt" or "regular salt" significantly increased consumers' likelihoods of choosing reduced-salt dishes in the unadjusted model (P < 0.1). CONCLUSIONS:Applying choice architecture changes as nudge-based interventions on MDAs were proven to be effective to promote consumers to order reduced salt dishes, and we consider these findings to have real-world implications for policymakers, researchers, and the private sectors.

Dietary intervention is crucial for the clinical management of alcoholic liver injury. As the primary bioactive component in fermented tea, theaflavin-3,3'-digallate (TF3) possesses potent antioxidative and anti-inflammatory capacities, but its protective mechanisms against alcoholic liver injury via the gut-liver axis require systematic elucidation. This study evaluated the protective effects and underlying mechanisms of high-purity TF3 (2.5/5/10 mg/kg, 12-week oral gavage) against alcoholic liver injury in C57BL/6 J mice. TF3 administration significantly reduced serum lipids, attenuated hepatic steatosis, and suppressed oxidative stress and pro-inflammatory cytokine production in alcohol-fed mice. Mechanistically, TF3 enhanced intestinal barrier integrity by upregulating tight junction proteins in the colon and ileum, increased beneficial microbiota like Lactobacillus and Bifidobacterium, and modulated microbial metabolites including short-chain fatty acids (SCFAs) and tryptophan. These changes reduced circulating lipopolysaccharide (LPS), suppressed hepatic toll-like receptor 4 (TLR4)/nuclear factor kappa-B (NF-κB) pathway activation, and ultimately ameliorated hepatic inflammation while enhancing oxidative stress regulation. This work reveals novel mechanisms of TF3 in preventing alcoholic liver injury, providing a theoretical foundation for dietary applications.

BackgroundSuboptimal diet remains a major threat to chronic kidney diseases (CKD) and hypertension, however, the burden of diet-attributable CKD due to hypertension (HCKD) has been poorly quantified and reported. This study aimed to provide a comprehensive and up-to-date view of global temporal and geographical trends in diet-attributable HCKD burden.MethodsData on diet-attributable HCKD burden were extracted from the Global Burden of Disease Study (GBD) 2021. Number and age-standardized rates (ASR) of mortality and disability-adjusted life years (DALYs) with their average annual percentage change (AAPC) were used to describe the diet-attributable HCKD burden. Decomposition analysis was employed to assess the contributions of aging, population, and epidemiological changes to HCKD burden.ResultsGlobally, the ASR of mortality (ASMR) and DALYs (ASDR) of diet-attributable HCKD among adults aged ≥25 years increased from 3.7 (95% uncertainty interval [UI]: 2.0–5.6) and 91.7 (50.1–140.1) per 100,000 population in 1990 to 4.3 (2.3–6.7) and 101.2 (56.0–154.5) per 100,000 population in 2021, respectively. Both mortality and DALYs of diet-attributable HCKD burden in 2021 were higher among males than females. Low fruit and low vegetable intake contributed the most to the diet-attributable HCKD burden. The highest ASMR and ASDR of diet-attributable HCKD were observed in Central Sub-Saharan Africa, whereas the lowest were observed in Eastern Europe. The older adult population had higher mortality and DALYs than other age groups. Decomposition analysis showed that population growth mainly contributed to HCKD burden, particularly in low SDI regions.ConclusionThe diet-attributable HCKD burden is increasing at an alarming rate globally, especially in low SDI countries and older adults. This study emphasizes the urgent need for rigorous public health interventions to change unhealthy dietary behaviors and decrease diet-attributable HCKD burden worldwide.

Obesity is prevalent worldwide and seriously affects human health. At present, there are many reports on the lipid-lowering and weight loss effect of Pu-erh tea water extract, catechin, and theanine, but there are few studies on the synergistic lipid-lowering and weight loss of the three as a combined formula. The purpose of this study was to explore the anti-obesity effect of Pu-erh tea compound solid beverage composed of Pu-erh tea water extract, catechin, and theanine on high-fat diet mice. In this study, C57BL/6J mice were induced using a high-fat diet to construct an obesity model, and Pu-erh tea solid beverage was given by intragastric intervention. After 8 weeks of intragastric administration, the body weight, serum TG, TC, LDL-C, and liver TG and TC levels in the solid beverage intervention group were significantly decreased. The expression levels of tight junction proteins ZO-1, Occludin, and Claudin-1 in colon tissue were significantly increased. 16S rRNA analysis showed that Pu-erh tea solid beverage delayed the increase of Blautia, Helicobacter, Colidextribacter high-fat diet, and increased the species abundance of the intestinal microbial community. The above results showed that Pu-erh tea solid beverage could inhibit obesity in high-fat diet mice by alleviating dyslipidemia, intestinal barrier damage, and intestinal flora disorders in high-fat diet-fed mice.

Introduction:Nutrition knowledge (NK) is a key modifiable factor influencing the dietary behavior and nutritional status of children. Currently, nationally representative data assessing NK among Chinese junior high school students are unavailable. This study aimed to assess NK levels using recent, nationally representative data from China. Methods:A multistage stratified random cluster sampling method was used to select 28,629 junior high school students from 195 survey sites across 31 provincial-level administrative divisions in China. Data were collected using a standardized questionnaire developed using rigorous scientific procedures. NK awareness rates were described as weighted prevalence rates with 95% confidence intervals (CIs). Subgroup comparisons were performed using the Rao-Scott chi-square test. Results:The overall NK awareness rate among Chinese junior high school students was 40.0% (95% CI: 36.5%-43.5%). The rates for the five dimensions, dietary recommendations, nutrient content of foods, food and health, food choices, and food safety, were 20.1%, 46.2%, 65.3%, 65.2%, and 65.2%, respectively. The analysis revealed significant variations in overall and dimension-specific awareness rates across groups. Boys, students from rural and western regions, and students from families with lower socioeconomic status had poorer NK levels than their counterparts. Among the 10 knowledge points with the lowest correct rates, seven belonged to dietary recommendations, two to food safety, and one to food and health. Conclusion:NK awareness rates among junior high school students require improvement, especially regarding dietary recommendations, which remain a key component of students' nutrition education. Boys, students from rural and western regions, and students from families with lower socioeconomic status should be the key populations for NK dissemination in the future.

Background/Objectives: Excessive intake of salt, oil, and sugar constitutes a major dietary risk factor for chronic diseases in China. Although salt, oil, and sugar reduction (“Three Reductions”) has been promoted at the national level, the population’s knowledge remains inadequately evaluated. This study aimed to assess the “Three Reductions” knowledge level among Chinese adults and its association with nutrition-related chronic diseases. Methods: Data were obtained from the Chinese Nutrition and Health Knowledge Survey 2022, a nationally representative cross-sectional study. A total of 68,673 participants aged 18–64 years were recruited from 200 survey sites of 31 provinces by multi-stage stratified random cluster sampling methods. A standard questionnaire was used for data collection, and multivariable logistic regression models were employed to examine factors associated with “Three Reductions” knowledge and its relationship with chronic diseases. All analyses were weighted by complex sampling. Results: In 2022, the mean “Three Reductions” knowledge score was 16.43 ± 4.17 (the full score is 24 points), and the awareness rate was 49.3% (95% CI: 47.0–51.6%). Females, those with higher education and income levels, those employed in medical institutions, and residents in urban and eastern areas had higher “Three Reductions” levels (p < 0.05). The “Three Reductions” knowledge level was significantly associated with chronic disease risk (p < 0.05). Specifically, the risk of chronic disease was reduced by 5% in the medium-score group (OR = 0.95, 95% CI: 0.90–1.00) and by 11% in the high-score group (OR = 0.89, 95% CI: 0.84–0.95). Conclusions: “Three Reductions” knowledge among Chinese is at a moderate level, with a significant association between “Three Reductions” knowledge level and chronic disease status. Dissemination of “Three Reductions” knowledge, especially practical knowledge, should be enhanced at the national level through various routes to reduce chronic disease risk.

The average salt intake of Chinese residents far exceeds the recommended standard. As food delivery becomes increasingly popular among the Chinese public, salt reduction for takeaways is important to reduce salt intake of Chinese residents. However, studies related to salt reduction of takeaways are still very few; especially, no study has explored consumers’ attitudes towards salt level in takeaway meals. The purpose of the study was to objectively measure consumers’ request for reduced-salt options when ordering meals online, from real takeaway orders. Consumer messages from 718 restaurants on a meal delivery app called ELEME in China were collected between July and December 2020. Reduced-salt messages from all consumer messages placed by consumers when ordering meals were extracted to determine the extent of customized salt reduction requests and to analyze the content of those requests. Feature words from messages identified through AI machine learning (Term Frequency and Term Frequency-Inverse Document Frequency method) were extracted and analyzed. Out of 25,982 consumer messages, 10,549 (40.6%) were reduced-salt messages. Consumers, in general, had the demand to customize dishes with less salt – “less salt” was the most frequently mentioned word for taste preference. Populations with special health and nutritional needs may have a higher demand for reduced-salt meals according to these messages. The study showed definite patterns of demand in a sizable minority of orders and identified the feature words and concepts that could feed into future efforts to create an effective choice architecture in online meal delivery platforms.

Green tea possesses a range of beneficial effects, including anti-obesity, antioxidant, and anti-inflammatory properties, owing to its biologically active components, primarily catechins such as epicatechin (EC), epicatechin gallate (ECG), epigallocatechin (EGC), and epigallocatechin gallate (EGCG). However, few studies have investigated the four catechin monomers simultaneously, and the molecular mechanisms of their anti-obesity effects have not been fully elucidated. In this study, we investigated the effects of four catechin monomers on the differentiation of 3T3-L1 preadipocytes of mice. Our findings demonstrated that four catechin monomers EC/ECG/EGC/EGCG (12, 25, 50 µM) dose-dependently inhibited the differentiation of 3T3-L1 preadipocytes and reduced triglyceride content. EGCG exhibited the most potent inhibitory effect with an optimal concentration of 50 µM. In addition, transcriptome sequencing and lipidomic analysis of EGCG-treated 3T3-L1 preadipocytes revealed that Ptgs2 and Pim1 were the most differentially expressed genes involved in regulating adipocyte differentiation. The results suggested that EGCG up-regulated the expression of the Pla2g2e gene and down-regulated the expression of the Pla2g4a and Pla2g2a genes via the glycerophospholipid metabolic pathway, which subsequently elevated lysophosphatidylcholine (LPC) levels, influencing the differentiation process of 3T3-L1 preadipocytes.

Background Chinese urban residents consume more salt from meals prepared outside home than in the past. The purpose of this study is to understand Chinese consumer demand for salt reduction as expressed through their orders on meal delivery apps (MDAs), restaurants’ willingness to promote salt reduction, and the extent to which restaurants comply with reduced salt requests. Methods We analyzed consumer comments extracted from 718 restaurants on a Chinese MDA called ELEME for orders made in the July-December 2020 timeframe. A self-designed questionnaire was distributed to the restaurant managers to assess restaurants’ attitude towards salt reduction upon signing up for the study, and laboratory validation was conducted to test whether dishes ordered with reduced salt requests by consumers actually contained less salt. Results A total of 25,982 (0.7%) orders out of 3,630,798 orders contained consumer comments. Of the consumer comments, 40.6% (10,549) were about requests for less salt in dishes. Totally 91.5% of 421 surveyed restaurants showed a willingness to respond to consumers’ reduced salt requests. The median sodium content measured in the reduced-salt dishes by the laboratory was significantly lower than that in their regular salt counterparts ( P < 0.05). Conclusions We observed substantial consumer demand for salt reduction while ordering meals on the MDA and that restaurants did, in response, reduce the sodium content in the meals they provided. As meals delivered via MDAs comprise an increasing proportion of outside foods consumed, there is an opportunity for public health experts and policy makers to work with MDAs and restaurants to promote healthier food selections. Trial registration ChiCTR2100047729.

Women aged 18–49 years are women of childbearing age. Their nutrition knowledge (NK) is not only related to their physical health but also affects the diet quality of the entire family and the health status of the next generation. Studies that assess the NK level of women of childbearing age using representative data in China are lacking. This study aimed to evaluate the NK level of Chinese women aged 18–49 years and explore influencing factors at both the individual and provincial levels. Data were from the Chinese Nutrition and Health Knowledge Survey 2021. A total of 38,065 females aged 18–49 years were included in the analysis. A face-to-face validated standard questionnaire was used to collect NK from respondents. The full score of the questionnaire was 100. Respondents who scored higher than 75 were considered to have NK. The Rao-Scott chi-square test was used to compare the differences in the NK awareness rate between or among the subgroups. A multilevel logistic regression model was used to explore influencing factors at the individual and provincial levels. All analyses accounted for complex sample design including clustering, stratification, and sample weights. The mean score of NK among Chinese women aged 18–49 years was 65.1 ± 11.8, and the awareness rate was 20.9% (95% CI: 19.6−22.3%). Among the five dimensions, the awareness rate of food safety was the highest (74.0%, 95% CI: 72.8−75.3%), and the dietary recommendation was the lowest (16.4%, 95% CI: 15.3−17.5%). The two-level logistic regression model analysis revealed that at the individual level, age, education level, occupation, chronic disease status and residence were the main influencing factors of the NK level. At the provincial level, the region and the female illiteracy rate were associated with the NK level. Dependent children ratio, per capita income, and health expenditure were not significantly associated with the NK level. The model accounted for 58.8% of the variance in the NK level. The NK level of Chinese women aged 18–49 years was low. Knowledge of dietary recommendations was weakest. Both individual and provincial-level factors were associated with the NK level. There is an urgent need to strengthen nutrition education actions for enhancing the NK of reproductive-age women effectively to improve their dietary behaviors.

BackgroundExcessive intake of sugar-sweetened beverages (SSBs) is harmful to health. In recent decades, the consumption of SSBs by Chinese residents has increased rapidly, increasing the risk of death and burden of disease. ObjectiveTo analyze the knowledge level and influencing factors of SSBs for Chinese residents aged 18-64 years in 2021. MethodsA multi-stage cluster random sampling approach was used to conduct a questionnaire survey among residents aged 18-64 years in 302 survey sites across the country in 2021, and 98567 valid questionnaires were obtained. Four questions are about SSBs among the questionnaire's 5 dimensions. Respondents who answered 3 or more questions correctly were considered to have a basic understanding of SSBs. Frequency and weighted proportion were used for description. With individual as level 1 and resident council (village council) as level 2, a two-level logistic regression model was applied to examine the influencing factors. A null model was used to determine whether the two-level logistic regression model was appropriate. ResultsThe knowledge awareness rate of SSBs was 57.0% among the Chinese residents aged 18-64 years in 2021. The knowledge point with the lowest correct rate was "It is best to consume no more than 25 grams of added sugar per day" (22.6%), while the one with the highest correct rate was "Excessive intake of SSBs can increase the risk of obesity and diabetes" (81.1%). The results of the null model showed that SSBs knowledge level had a clustering effect at resident council (village council) level (t=25.00, P<0.0001), so a two-level model fit better than a one-level model. The results of the two-level logistic model revealed that residents who were female (OR=1.14, 95%CI: 1.11, 1.18) or working in medical and health (OR=1.36, 95%CI: 1.27, 1.45) and education institutions (OR=1.16, 95%CI: 1.07, 1.24) had a higher knowledge level compared to males or residents of other occupations. The knowledge level was lower among residents in central (OR=0.87, 95%CI: 0.77, 0.97) and western (OR=0.85, 95%CI: 0.75, 0.94) areas than in eastern areas. Those with chronic diseases (OR=0.81, 95%CI: 0.78, 0.84) and who did not know if they had a chronic disease (OR=0.75, 95%CI: 0.72, 0.78) had a lower knowledge level than those without chronic diseases. Compared with 18-24 years, the knowledge level was higher in ages 35-44 years (OR=1.07, 95%CI: 1.02, 1.12) and lower in ages 55-64 years (OR=0.92, 95%CI: 0.86, 0.97), and not different from the ages 25-34 years and 45-54 years. The knowledge level increased with the level of education, the trend was statistically significant (P＜0.001). ConclusionOnly about half of Chinese adults aged 18-64 years had a basic understanding of SSBs in 2021. The awareness rate of added sugar intake was low in particular. The knowledge levels of male, central and western, or less educated populations were even lower. Awareness of the negative health outcomes of SSBs was high among the population.

Objective To explore the effectiveness of healthy school canteen intervention on nutritional literacy, food consumption, as well as attitude towards school canteen. Methods A primary school in Taizhou City was selected as the intervention school, and another comparable primary school was selected as the control one. A total of 320 students（163 in the intervention group and 157 in the control group） received a comprehensive intervention based on the construction of a healthy school canteen in the school, incluling healthy dining environment, food impravement, chef training, nutrition and health education, while the control group did not receive any intervention. Questionnaires survey was administered to both groups before and after the intervention. Results Before the intervention, no significant differences were found in the total scores of skills and nutrition literacy, frequency of food intake, behaviors and attitudes related to canteen construction between the two groups（P＞0.05）. Daily intake of vegetables, dairy products, fish/poultry/eggs/lean meat increased by 19.63, 15.95 and 19.63 percentage point respectively（χ~2=15.25,9.14,13.93,P＜0.01）. The proportion of students reporting have read related intervention materials in the intervention group（95.71%） was higher than the control group（84.71%）（χ~2=11.04, P＜0.01）. The students in favor of low-salt, low-oil and low-sugar dishes in the intervention group（74.85%） was higher than in the control group（48.41%）（χ~2=23.73,P＜0.01）. Conclusion Based on the comprehensive intervention of nutrition and health canteens can improve students’ nutrition literacy and dietary structure. It is recommended to adopt the form of "home-school linkage" to carry out the construction of large-sample, multi-regional and long-term nutrition and health canteens.

Alcoholic liver disease (ALD) remains a major cause of liver-related morbidity and mortality worldwide. Tea polyphenols (TPs) possess strong antioxidant activity; cassia seed extract (CSE) has the effect of brightening the eyes; and Ampelopsis grossedentata extract (AGE) has the function of protecting the liver. However, the synergistic hepatoprotective effect of TP, AGE and CSE as a joint formulation is unknown. This study aimed to investigate the role of a tea solid beverage, composed of TP, AGE and CSE, on chronic alcoholic liver injury in rats and its underlying mechanisms via the analysis of transcriptomics and gut microbiota. The histopathological findings revealed that the tea solid beverage could reduce the production of fat vacuoles and inflammatory cell infiltration. Additionally, the tea solid beverage was found to effectively relieve the increase in the AST (from 424.85 U/L to 180.17 U/L), ALT (from 139.95 U/L to 85.88 U/L) and LDH (from 21.16 U/L to 13.35 U/L) enzyme activities and the expression of the inflammatory factors TNF-α (from 394.02 pg/mL to 214.44 pg/mL) and IL-6 (from 208.46 pg/mL to 116.59 pg/mL) caused by alcohol consumption. Further, it significantly enhanced the GSH concentration (from 4.53 pg/mL to 8.08 pg/mL) and SOD activity (from 84.70 U/mL to 156.94 U/mL) and decreased the MDA (from 58.61 mmol/mL to 36.58 mmol/mL) and TG (from 7.07 mmol/L to 3.43 mmol/L)) concentrations in the liver of rats. The analysis and identification of transcriptomics showed that the tea solid beverage intervention primarily protected the liver of rats with chronic alcoholic injury by up-regulating the differential gene Hmgcs1 in order to increase the synthesis of ketone bodies and by down-regulating the differential gene Pfkfb1 for the purpose of decreasing the glucose metabolism. Additionally, it was found that the tea solid beverage could significantly change the composition of intestinal flora in drinking rats by regulating mineral absorption, the pathways of bile secretion, the adipocytokine signaling pathway and the peroxisome balance of the intestinal flora, in order to protect alcohol-drinking rats' livers. In conclusion, the tea solid beverage, consisting of TP, AGE and CSE, is a functional drink that prevents ketone metabolism, glucose metabolism and microbiome disorders induced by alcohol intake.