Aim To assess the application of current waist-to-height ratio (WHtR) and waist circumference (WC) evaluation criteria and identify preferred recommendations for public health practise.Materials and Methods Data were from three waves of the Chinese National Survey on Students Constitution and Health (CNSSCH) conducted in 2010, 2014 and 2019; abdominal obesity was classified using four WHtR and WC standards. Age- and sex-specific WHtR and WC percentile curves were generated using the LMS method. Prevalence of central adiposity by WHtR/WC and general obesity by BMI were compared. Predictive performance of the criteria was validated using an independent dataset with cardiometabolic risk factors.Results WHtR percentile curves showed a relatively flat trend with age in both sexes compared to WC curves. Abdominal obesity prevalence increased significantly from 2010 to 2019 across all criteria: international cut-off (0.46) (21.26%-27.66%), Chinese WC cut-offs (13.77%-19.64%), international WHtR cut-off (0.50) (9.12%-13.01%) and international WC cut-offs (7.95%-11.95%). All abdominal obesity criteria identified substantially more cases than BMI-based general obesity in 2019 (8.14%). The Chinese WC cut-offs showed superior predictive performance compared to the other three standards for cardiometabolic outcomes.Conclusions The Chinese WC cut-offs and international cut-off (0.50) are optimal for childhood abdominal obesity screening in China due to their public health applicability. Standardized global criteria are urgently needed to enhance research comparability.

Background:The 2021 World Health Organization and United Nations Children's Fund definition of minimum dietary diversity (MDD) includes breast milk as an eighth food group. However, cross-country evidence under this revised definition remains limited. We estimated MDD achievement among children in low- and middle-income countries (LMICs) and examined its associations with anaemia, stunting, underweight, and overweight/obesity (OWOB). Methods:We analysed the most recent Demographic and Health Survey completed between 2000 and 2023 in 62 LMICs, comprising 123,569 children aged 6-23 months. We constructed MDD from standard DHS recode food-consumption variables according to the 2021 WHO/UNICEF definition, with achievement defined as consumption of at least five of eight food groups in the previous 24 hours. We estimated associations using survey-weighted logistic regression with country fixed effects and prespecified covariates. Complementary analyses included restricted cubic splines, a two-stage individual-participant-data meta-analysis, and ecological analyses. Results:Overall, 27.0% of children achieved MDD and 73.0% did not, with rates increasing from 17.7% in low-income countries to 42.9% in upper-middle-income countries. Binary MDD achievement was associated with lower odds of stunting across income groups (adjusted odds ratio (aOR) ranging from 0.677 to 0.822) and underweight (aOR ranging from 0.695 to 0.782). Continuous-score and categorical analyses showed similar patterns, whereas individual-level with anaemia and OWOB were not consistent. National MDD prevalence was inversely correlated with stunting (weighted R = -0.686; P < 0.001), underweight (weighted R = -0.678; P < 0.001), and anaemia (weighted R = -0.373; P = 0.003), but not with OWOB (weighted R = 0.068; P = 0.597). Conclusions:In our study, MDD achievement was low across 62 LMICs and varied substantially across countries and by urban or rural residence and household wealth. Greater dietary diversity was associated with lower odds of stunting and underweight across the primary income-stratified models, whereas individual-level associations with anaemia and OWOB were not consistently observed across model specifications. Policies should prioritise equitable access to affordable, nutrient-dense complementary foods, particularly in sub-Saharan Africa and socioeconomically disadvantaged populations.

Background: Early puberty has been associated with various adverse health outcomes. We aimed to characterize the spatiotemporal patterns of age at menarche or spermarche in China and to identify potential associated factors. Methods: We leveraged data from six consecutive nation-wide cross-sectional surveys in China conducted in 1995, 2000, 2005, 2010, 2014, and 2019. A total of 519 940 girls aged 9 to 18 years and 392 813 boys aged 11 to 18 years from 30 provinces in Mainland China were included. Probabilistic analysis was used to estimate the median ages at spermarche or menarche as surrogate measures of pubertal development. We used Bayesian spatiotemporally varying series models with the spatiotemporal variance partitioning index to assess the spatiotemporal heterogeneity of ages at menarche or spermarche across 30 provinces and to quantify the relative contributions of the socioeconomic and environmental factors. Results: Almost all provinces experienced decreases in the median ages at spermarche and menarche during the study period. Regional disparities were identified, as a faster decreasing trend was generally observed in eastern provinces when compared with western provinces. Socioeconomic factors explained 34.58% of the spatiotemporal heterogeneity for boys and 34.17% for girls, while environmental factors explained 55.68 and 56.22%, respectively. Among these, temperature, nighttime light, nitrogen dioxide, relative humidity, and illiteracy rate showed the largest contributions (each >5%). In general, higher levels of economic indicators and environmental stressors were observed in provinces with lower initial ages at spermarche and menarche and/or faster declining trends. Conclusions: A significant trend toward early puberty was observed in China over the past 25 years, especially in eastern provinces. Both socioeconomic and environmental factors were strongly associated with the observed spatiotemporal patterns.

Excessive classroom noise is an important, but under-addressed, environmental health concern in schools, with potential implications for students' listening conditions, learning, and hearing health. This study examined classroom noise exposure among Chinese students and evaluated whether a Classroom-oriented Distributed Acoustic Equalization Intervention (C-DAEI) improved classroom acoustics, speech intelligibility, and hearing-related outcomes. The study combined large-scale cross-sectional surveillance with a six-month cluster-randomized, parallel-group field intervention. Surveillance data from 398,629 students selected through stratified cluster sampling between 2019 and 2023 were used to assess classroom indoor noise across school settings. The intervention included 295 students and compared classrooms equipped with C-DAEI with classrooms using standard sound reinforcement. Outcomes included standardized acoustic indicators, speech intelligibility, and pure-tone audiometry in a symptomatic subsample. Nearly half of student-linked classrooms exceeded national noise limits, with non-compliance more frequent in urban than rural schools. Compared with standard sound reinforcement, C-DAEI improved sound-field uniformity and speech transmission conditions. Students in the intervention group achieved higher post-intervention speech accuracy than controls. Audiometric changes were modest, but hearing thresholds showed favourable trends. These findings suggest that optimized classroom sound reinforcement may be a practical school-based strategy for improving listening environments and supporting hearing health.

Background: The rising prevalence of childhood overweight/obesity (OWOB) and elevated blood pressure (EBP) parallels a global decline in muscular fitness. However, evidence linking whole-body muscular strength to the comorbidity of these cardiometabolic risks remains scarce. Methods: Data were obtained from five nationally representative waves of the Chinese National Survey on Students' Constitution and Health (CNSSCH, 2000-2019), including 1,072,404 children and adolescents aged 7-18 years. A novel Muscle Strength Index (MSI) was developed by integrating handgrip strength (HGS) and standing broad jump (SBJ), standardized for body weight and height, respectively. Generalized linear mixed-effects models (GLMMs) with restricted cubic splines (RCS) were first applied to characterize dose-response associations. Subsequently, categorical analyses and forest plots were conducted to quantify risks of OWOB, EBP, and their comorbidity across five waves and subgroups. Sex-specific normative reference curves were established using the LMS method, and population-attributable fractions (PAFs) were estimated to assess the potential public health benefits of improving muscular strength. Results: Between 2000 and 2019, the prevalence of OWOB, EBP, and comorbidity increased markedly, reaching 25.80%, 12.23%, and 4.83% in 2019, and are projected to rise further to 37.88%, 20.16%, and 10.01% by 2030. Over the same period, mean MSI increased from 2000, peaked in 2005, and subsequently declined by 2019 with the values for boys and girls, being 1.73, 1.75, 1.63 and 1.46, 1.49, 1.41, respectively. Dose-response analyses revealed consistent L-shaped associations, with the greatest risk reductions observed when moving from low to moderate MSI levels. In 2019, participants with low MSI had higher odds of OWOB (OR 4.81, 95% CI 4.65-4.97), EBP (OR 1.42, 95% CI 1.36-1.49), and comorbidity (OR 3.49 95% CI 3.26-3.73) compared with those at middle levels. PAF analyses indicated that improving MSI to at least the 40th percentile could potentially avert 43.5% of OWOB cases, 12.3% of EBP cases, and 48.2% of comorbidity cases. The highest potential benefits were observed in northern and northeastern provinces, particularly Tianjin and Heilongjiang. Conclusions: Chinese children and adolescents face a dual burden of rising cardiometabolic comorbidity and declining muscular strength. Muscular strength demonstrates a strong nonlinear protective association with OWOB, EBP, and their co-occurrence. Targeted improvement among those with low muscular strength may substantially reduce future cardiometabolic burden.

OBJECTIVE:The shift from overweight to obesity predominance and the parallel rise in severe obesity among youth remain insufficiently characterized. This study examines the timing and pattern of this "Obesity-Overweight Reversal" in China. METHODS:We analyzed individual-level data from six cycles (1995-2019) of the Chinese National Survey on Students' Constitution and Health. Trends and projections to 2030 were estimated using multinomial logistic regression. Associations between severe obesity and Human Development Index (HDI) were assessed using generalized additive models. RESULTS:From 1995 to 2019, BMI z-score distributions shifted rightward and broadened across demographic groups. Obesity-Overweight Reversal first appeared among urban boys in Tianjin by 2010 and expanded to additional provinces, particularly among boys in the Northeast. Severe obesity rose sharply, reaching 7.66% in Shandong boys in 2019; among girls, severe obesity remained lower but was projected to surpass 5% in the Northeast in 2030. The HDI-severe obesity associations were nonlinear, with a plateau at very high HDI. CONCLUSIONS:China has entered a turning point in the pediatric obesity epidemic since 2010. Pronounced subnational and sex-residence disparities point to the need for context-specific interventions. Monitoring BMI distribution shifts, severe obesity trends, and socioeconomic correlates is essential to inform prevention strategies.

BACKGROUND:This study described the transition of overweight and obesity (OWOB) from 2019 to 2020 among Chinese children and adolescents and explored the association of physical fitness with OWOB incidence, persistence, and progression. METHODS:A total of 4429 children and adolescents aged 9-18 years in China finished physical fitness assessments and anthropometric measurements in November 2019, with follow-up assessments of height and weight conducted in November 2020. The extended International Obesity Task Force standard was applied to classify nutritional status. Participants with normal nutrition in 2019 and newly identified as OWOB in 2020 were defined as having OWOB incidence. Individuals with OWOB in 2019 and remaining at the same level of nutrition in 2020 were defined as having OWOB persistence. Participants with OWOB in 2019 and progressing to a more severe level of nutrition in 2020 were defined as having OWOB progression. Physical fitness indicator (PFI) was computed by sex- and age-specific Z scores of 6 components as follows: PFI = Zforced vital capacity + Zsit-and-reach + (-Z50-m dash) + Zstanding long jump + (-Zendurance running) + Zbody muscle strength. The PFI values were then classified into low, low-middle, middle, middle-high, and high levels based on the sex- and age-specific quintiles. RESULTS:The overall incidence of OWOB from 2019 to 2020 was 12.9%, with a higher incidence in children aged 9-12 years and boys. The percentages of OWOB persistence and progression were 10.7% and 1.8%, with children aged 9-12 years and boys at a higher risk for OWOB persistence, and boys at a higher risk for OWOB progression. Compared to individuals with a low-level PFI, children and adolescents with a high-level PFI were at a lower risk for OWOB incidence (OR = 0.55, 95% confidence interval [CI]: 0.36 to 0.83), while individuals with low-middle (OR = 0.65, 95% CI, 0.49 to 0.86), middle (OR = 0.34, 95% CI, 0.24 to 0.46), middle-high (OR = 0.32, 95% CI, 0.24 to 0.44), and high (OR = 0.14, 95% CI, 0.09 to 0.20) levels of PFI had a lower risk for OWOB persistence, and individuals with middle (OR = 0.21, 95% CI, 0.09 to 0.48), middle-high (OR = 0.34, 95% CI, 0.17 to 0.65), and high (OR = 0.16, 95% CI, 0.07 to 0.37) levels of PFI were at a lower risk for OWOB progression. CONCLUSIONS:This longitudinal study found that a higher physical fitness level in children and adolescents was inversely associated with OWOB incidence, persistence, and progression, suggesting that enhancing physical fitness might serve as a promising intervention strategy to alleviate the OWOB burden in Chinese children and adolescents.

Background:Age at menarche (AAM) is a critical marker of female development and long-term health. While its global decline has been documented, its developmental trajectories and heterogeneity among China's large ethnic minority populations remain poorly characterised. We sought to explore the temporal trends and differences in AAM between 26 major ethnic minority groups and their Han peers in China, and to examine the role of economic development in shaping these patterns. Methods:We retrieved data on 190,064 girls from seven waves (1985-2019) of the Chinese National Survey on Students' Constitution and Health, covering 26 minority groups and local Han peers across 13 provincial-level regions. We estimated the median AAM and its 95% confidence interval (CI) via probit regression based on status quo menarcheal data. We assessed intergroup differences using Z-tests, identified distinct trajectories of differences in AAM between 25 minority groups and their local Han peers through K-means clustering; and examined associations between AAM and log-transformed prefecture-level per capita GDP using quadratic regression models. Results:The median AAM among minority girls in 2019 was 12.54 years, later than that of Han girls (12.05 years), with an overall difference of 0.49 years and substantial interethnic heterogeneity. The AAM declined across all minority groups from 1985 to 2019, albeit at different rates. Three trajectories of minority-Han differences were identified: a 'rapid catch-up' pattern (n/N = 13/25 groups), an 'emerging divergence' pattern (n/N = 8/25 groups), and a 'fluctuating/stable' pattern (n/N = 4/25 groups). These clusters exhibited a clear gradient in regional economic development. Economic growth showed a nonlinear association with AAM, with stronger declines at lower development levels and a plateau at higher levels. Conclusions:Although regional economic development was associated with AAM among ethnic minorities in China, convergence with Han peers remains uneven. The nonlinear association with economic growth suggests diminishing returns of development, underscoring the need for targeted public health strategies addressing both persistent deprivation and modernisation-related risks.

Cardiovascular health disparities across ethnic groups have been well-documented in adults, but temporal patterns in children and underlying molecular mechanisms remain poorly understood. We analyzed two cohorts: the China Health and Nutrition Survey (CHNS, 1991-2015) with 8,062 children (13.7% minorities) and a contemporary regional Shimian County study (2021-2024) with 3,612 children (32.5% minorities, primarily Yi and Tibetan). We assessed blood pressure, anthropometrics, echocardiographic parameters, and sociodemographic factors. A nested case-control lipidomics study (n = 111) characterized ethnicity-specific molecular signatures. CHNS ethnic minority children demonstrated significantly lower odds of elevated blood pressure compared to Han Chinese (adjusted OR for elevated blood pressure: 0.85, 95% CI: 0.74-0.98, P = 0.028), with Han children exhibiting higher systolic blood pressure (98.3 ± 0.1 vs 97.1 ± 0.3 mmHg, P < 0.001). This association was not evident in the Shimian cohort (adjusted OR: 0.90, 95% CI: 0.76-1.07, P = 0.253). Cardiac structural analysis showed that left ventricular dimensions appeared larger in minority children. After body surface area indexing, ethnic differences in cardiac structure were largely attenuated, with systolic function preserved in both groups. Lipidomic profiling identified distinct ethnic-specific molecular signatures: Han children with hypertension showed diacylglycerol upregulation correlating with cardiac parameters (r = 0.45-0.62, P < 0.05), while in minority children triacylglycerol elevation and phosphatidylethanolamine reduction correlated with vascular function indices, though these associations were largely attenuated after adjustment for BMI z-score. Ethnic-specific lipidomic phenotypes may reflect distinct metabolic contexts of pediatric hypertension that warrant mechanistic and longitudinal investigation.

This study aimed to analyze the secular trends and urban–rural inequalities in comprehensive physical fitness among Chinese children and adolescents over a span of two decades, while further assessing the non-linear association between urbanization and physical fitness. Using data from six cycles (1995–2019) of the Chinese National Survey on Students’ Constitution and Health, we included 1,278,504 children and adolescents aged 7–18 years. Physical fitness was assessed via six core components and aggregated into a summary physical fitness indicator (PFI). Nutritional status was assessed using body mass index in accordance with the World Health Organization criteria. Provincial urbanization rates were obtained from the National Bureau of Statistics. Mixed-effects linear models assessed differences in trends of PFI between the 1995–2005 and 2010–2019 periods. Quantile regression models evaluated urban–rural inequalities, and generalized additive models examined non-linear relationships between urbanization rates and PFI. Boys’ PFI declined markedly from 1995 to 2005, then remained relatively stable from 2010 to 2019, with a significant difference in trend slopes between the two periods (β = 0.16, 95

Objective:To evaluate the independent effects of prepregnancy obesity and gestational weight gain on fetal growth patterns and explore whether prepregnancy obesity can modify the association between gestational weight gain and fetal growth trajectories. Methods:A multicenter retrospective cohort was established, consisting of 9075 women with singleton pregnancies across 24 tertiary hospitals in 18 Chinese provinces. Each participant underwent a minimum of three ultrasound examinations between gestational week 12 and the conclusion of pregnancy. Fetal anthropometric measurements included biparietal diameter, abdominal circumference, head circumference, and femur length, with the estimated fetal weight (EFW) calculated using the Hadlock formula. Fetal growth trajectories were modeled using a linear mixed model with cubic splines, adjusted for maternal characteristics. Differences in trajectories were compared across categories of prepregnancy body mass index (BMI) and gestational weight gain. Global and week-specific comparisons were evaluated using the likelihood ratio test and the Wald test, while effect modification was assessed through stratified analysis. Results:Fetal weight was positively associated with prepregnancy BMI and gestational weight gain. From gestational week 12 through week 40, the EFW significantly differed among the offspring of women categorized as underweight, normal weight, overweight, or obese. Specifically, fetuses of women with obesity presented a significantly higher EFW than those of women in the other groups. When stratified by gestational weight gain (inadequate, adequate, and excessive), significant differences in EFW were observed from gestational week 16 until the conclusion of the pregnancy. Stratified analysis indicated that prepregnancy BMI modified the association between gestational weight gain and fetal growth trajectories. In women without obesity, gestational weight gain was significantly and positively associated with EFW and abdominal circumference; however, in women with obesity, gestational weight gain did not demonstrate a significant effect on fetal growth trajectories. Conclusion:Our data showed that prepregnancy BMI and gestational weight gain were positively associated with fetal growth. Furthermore, prepregnancy BMI acted as an effect modifier in the relationship between gestational weight gain and fetal growth trajectories. These findings suggested that weight control before conception carries greater clinical significance than the management of gestational weight gain.

Given widespread antibiotic use and residues, this study examined associations of multi-class urinary antibiotic exposure with childhood overweight and obesity (OWOB) risk, identified potential dietary sources, and explored lipidomic signatures and potential indirect effects. We analyzed two cohorts from China: the 4C cohort (Inner Mongolia, 2024; n = 692) for diet-exposure analyses and the CBPEF cohort (Xiamen, 2018/2020; n = 594) for repeated-measures exposure-adiposity and lipidomics analyses. Twenty-four urinary antibiotics across six classes were measured by LC-MS/MS. BMI percentile, OWOB, and untargeted serum lipidomics were assessed, with lipidomics performed in a CBPEF subsample of 73 children. Multi-class antibiotic exposure and co-exposure were common in both cohorts, with >94% of children in the 4C cohort and ≥98% in the CBPEF cohort having at least two detected antibiotics. In the 4C cohort, fish/seafood intake was associated with higher detection of sulfonamides, tetracyclines, and quinolones, with the strongest diet-exposure association observed for seafood intake and sulfonamide detection (OR = 2.17, 95% CI: 1.05-4.48), whereas plant-based intake was inversely associated with total detected antibiotic counts (β = -0.492). In the CBPEF cohort, each additional antibiotic detected was associated with a 0.63-point increase in BMI percentile (95% CI: 0.34-0.92), and each additional human antibiotic detected was associated with 14% higher odds of OWOB (OR = 1.14, 95% CI: 1.04-1.24). Cumulative sulfonamide, quinolone, macrolide, tetracycline, and phenicol counts were positively associated with BMI percentile (β range: 1.15-2.45). Lipidomic analyses identified 102 candidate lipids shared by urinary antibiotic exposure metrics and BMI percentile, with PC1-based indirect-effect signals across multiple antibiotic classes and pathway annotations mainly involving steroid/cholesterol-related metabolism. These findings suggest that contemporary Chinese children and adolescents commonly experience multi-class antibiotic exposure, particularly involving quinolones and macrolides, which may partly reflect dietary and environmental sources and contribute to childhood obesity risk, with lipidomic signatures suggesting involvement of steroid/cholesterol-related metabolism.

Background/Objectives: The association between sleep deprivation and mental well-being in school-aged children and adolescents has been well documented, but the specific relationship between sleep debt and mental well-being remains unclear. This study aimed to evaluate the association between sleep debt and mental well-being in school-aged children and adolescents. Methods: This cross-sectional study included 4967 children and adolescents aged 9-18 years from eight provincial-level regions in China, using data from a multicenter school-based survey conducted within the framework of the Chinese National Survey on Students' Constitution and Health (CNSSCH). Participants self-reported relevant sleep parameters, and the sleep debt was calculated based on the difference in sleep duration between weekdays and weekends. The main outcome was mental well-being. Adjusted covariates were age, sex, urban-rural residence, body mass index (BMI), vital capacity, and waist-to-hip ratio. Results: A total of 4967 children and adolescents were included (mean [SD] age 12.77 [2.59] years; 2475 [49.83%] girls) with 3176 participants classified as having higher mental well-being and 1791 participants classified as having lower mental well-being. After adjustment for covariates, sleep debt was associated with greater odds of lower mental well-being (adjusted odds ratio [aOR] = 1.095; 95% CI, 1.050-1.143; p < 0.001). Although statistically significant, the magnitude of this association was modest. In stratified analyses, each quartile increase in sleep debt was associated with 17.8% higher odds of lower mental well-being in boys (95% CI, 8.6-27.8%), 33.8% higher odds in girls (95% CI, 23.8-44.6%), 25.3% higher odds in urban students (95% CI, 16.3-35.0%), and 28.2% higher odds in rural students (95% CI, 17.6-39.7%) (all p < 0.001). In addition, weekend sleep patterns significantly interacted with the sleep debt-mental well-being association (p for interaction < 0.05), while age-specific nonlinear patterns involving nap duration were observed among adolescents aged 15-17 years (p for nonlinearity = 0.004). Conclusions: Sleep debt showed a statistically significant but modest cross-sectional association with lower mental well-being. Numerically larger subgroup-specific estimates were observed among girls and rural students. Given the cross-sectional design, these findings should not be interpreted as evidence of causality. Despite its modest magnitude, the association may have public health relevance at the population level. The observed patterns involving weekend sleep and age-specific nap duration warrant further evaluation in longitudinal and, where appropriate, intervention studies.

As the prevalence of cardiovascular risk factors in children continues to rise globally, identifying modifiable lifestyle factors becomes increasingly important for early prevention. Here, using data from a large-scale cohort (2021-2024) involving 7459 Chinese children from three provinces, we examine the association between eating timing patterns and multiple cardiovascular parameters. Participants are classified into three eating patterns: extended eating window (duration more than 12.5 hours), late eating window (duration 12.5 hours or less with last meal after 20:00), and early eating window (duration 12.5 hours or less with last meal at or before 20:00). Early eating window is associated with a 26% lower risk of elevated blood pressure (odds ratio: 0.74, 95% confidence interval: 0.65-0.84, p < 0.001) compared to extended eating window. We conduct a nested case-control study (n = 51) with comprehensive lipidomic and proteomic analyses. Proteomics identifies 83 differentially expressed proteins, with enrichment in cardiac muscle contraction and lipid metabolism pathways. Mediation analysis demonstrates that triacylglycerols mediate 64.8% of the effect between eating patterns and blood pressure. Our findings suggest associations between early eating windows and protective cardiovascular parameters in children, potentially mediated through lipid metabolism pathways.

The association of atherogenic index of plasma (AIP) control level with hypertension onset in children was still unclear. This study aimed to investigate the association between AIP control levels and risk of childhood hypertension. We obtained data from 12,800 students participating in a national, multi-center, school-based health lifestyle intervention program aimed at combating obesity. AIP was calculated using the formula log10(TG/HDL-C), and was categorized into five clusters based on baseline and 1 year follow-up values. Logistic regression and restricted cubic spline regression models were employed to explore both linear and nonlinear associations between AIP control and hypertension risk. Of the 12,800 students, 830 (6.5%) developed hypertension within 1 year. Compared to the group with optimal AIP control (Class 1), students in Class 4 with poor AIP control (OR = 1.75; 95% CI: 1.31-2.33; p < 0.001), and those in Class 5 with the worst AIP control (OR = 2.43; 95% CI: 1.69-3.50; p < 0.001), had higher incidences of hypertension. Restricted cubic spline regression analysis revealed a nonlinear relationship between AIP control and hypertension risk overall, and in Class 4 (p for nonlinear <0.05). However, the association was linear in the other classes (p for nonlinear >0.05). In conclusion, the level of AIP control was associated with the incidence of hypertension in children and adolescents.

Background: Phthalate exposure has been linked to adverse cardiometabolic profiles in children, but its association with longitudinal cardiometabolic risk patterns and the modifying role of 24-h movement behaviors remain unclear. Methods: We analyzed repeated follow-up data from a school-based cohort of Chinese children from 2018 to 2020. Urinary phthalate metabolites were measured annually and averaged to represent habitual exposure. Cardiometabolic risk status was classified into five progression patterns: stable healthy, improving, fluctuating, worsening, and persistently abnormal. Multinomial logistic regression was used to examine associations between phthalate exposure quartiles and progression patterns. Effect modification by sex and adherence to the 24-h movement guidelines was evaluated, and weighted quantile sum regression was used to assess mixture effects. Results: Most phthalate metabolites showed limited or inconsistent associations with stable healthy, improving, or fluctuating patterns. In contrast, higher exposure to several high-molecular-weight phthalate metabolites was associated with increased odds of the persistently abnormal pattern, particularly for MEOHP and MEHHP. Associations with worsening patterns were generally inconsistent. Sex-stratified analyses suggested stronger associations among boys, although formal interaction evidence was limited. Adherence to the 24-h movement guidelines was associated with weaker exposure-outcome associations, but estimates were imprecise. Mixture analyses showed a positive association between overall phthalate exposure burden and the persistently abnormal pattern. Conclusions: Repeated phthalate exposure was mainly associated with persistently abnormal cardiometabolic risk in children. Healthy movement behaviors may partly mitigate these associations, although further longitudinal studies are needed.

BACKGROUND:Previous studies have focused on double burden of malnutrition (DBM), involving overweight/obesity (OWOB) and undernutrition, primarily at individual or household levels. OBJECTIVES:This study aimed to assess evolving patterns and inequalities in DBM and triple burden of malnutrition (TBM) across 1995-2019 at both individual and population levels among Chinese children and adolescents. METHODS:Data were from the Chinese National Survey on Students' Constitution and Health, including 1,290,214 participants aged 7 to 18 y. OWOB, undernutrition, and anemia were assessed according to World Health Organization criteria. DBM and TBM were categorized into 4 patterns at both levels. Population-level DBM and TBM were defined as the coexistence of malnutrition forms within the same population rather than within individuals. Temporal trends were assessed using annual percent change (APC) estimated by Joinpoint regression for 1995 to 2010, 2010 to 2019, and 1995 to 2019. RESULTS:During 1995 to 2010, OWOB increased, whereas undernutrition and anemia declined; during 2010 to 2019, OWOB rose rapidly, undernutrition continued to decline, and anemia plateaued. At the individual level, OWOB + undernutrition increased after 2010 [APC = 2.87%, 95% confidence interval (CI): 1.03%, 4.85%], and OWOB + anemia increased steadily across 1995 to 2019 (APC = 4.83%, 95% CI: 3.64%, 6.44%). At the population level, OWOB + undernutrition and OWOB + anemia increased more rapidly during 2010 to 2019 than during 1995 to 2010. Although the prevalence of individual-level TBM remained rare (<0.05%), the combined prevalence of TBM declined from 38.59% (1995) to 34.16% (2005), then increased to 39.91% (2019), with an APC of 1.11% (95% CI: 0.67%, 1.58%) during 2010 to 2019. OWOB-related DBM and TBM were more prevalent among younger and urban boys, whereas rural boys experienced steeper increases after 2010. Northeastern and western provinces bore the heaviest DBM and TBM, linked to lower socioeconomic development. CONCLUSIONS:The post-2010 period marked a critical nutrition transition in China, characterized by rapidly rising OWOB + anemia at both levels and increasing population-level TBM. Reducing malnutrition burden requires nutrition-sensitive, equity-focused strategies that tackle undernutrition, OWOB, and micronutrient deficiency together.

Background/Objectives: The potential of relative grip strength as a biomarker for cardiovascular risk in college students is not well understood. Methods: Blood pressure status and grip strength metrics were analysed with multivariate logistic regression and restricted cubic spline models, utilising nationwide cross-sectional data from 42,591 Chinese college students. Results: After adjustment, higher absolute grip strength increased hypertension risk (High-level OR = 2.66; 95% CI: 2.21-3.20). In contrast, higher relative grip strength not only reduced risk overall (High-level OR = 0.41; 95% CI: 0.36-0.46) but also demonstrated consistent protective effects across all BMI subgroups (e.g., OR = 0.83 in overweight/obese individuals). Conclusions: Relative grip strength may present a valuable biomarker for cardiovascular risk assessment and the easy identification of at-risk individuals in all BMI categories.

Background and purpose Handgrip strength (HGS) and standing long jump (SLJ) are widely used field tests for assessing the localized maximal isometric force and dynamic lower-body explosive performance, respectively. We compared their associations with hypertension and severe hypertension and examined the variation across body-size-related expressions. Methods We analyzed 635 677 participants aged 7–18 years from the 2010, 2014, and 2019 Chinese National Survey on Students’ Constitution and Health. Eight metrics were evaluated: absolute HGS, SLJ, and each test relative to height, weight, and body mass index (BMI). Metrics were converted to survey year-, sex-, and age-specific deficit Z-scores. Generalized linear mixed-effects models with school random intercepts adjusted for age, sex, urban-rural residence, and endurance running performance. Restricted cubic splines were used to assess nonlinear associations. Results The direction of HGS associations differed across metric expressions. Deficits in absolute and height-relative HGS were inversely associated with both outcomes, whereas deficits in weight- and BMI-relative HGS were positively associated with both. Deficits in the expression of all four SLJ were positively associated with hypertension and severe hypertension across the three survey waves, although the magnitude varied by metric. SLJ/weight, yielded the largest estimates. The odds ratios for hypertension were 1.54, 1.70, and 1.60 in 2010, 2014, and 2019, respectively; the corresponding estimates for severe hypertension were 1.88, 2.10, and 1.84. Nonlinear analyses showed progressively steeper increases in the odds of both outcomes at higher HGS/weight and SLJ/weight-deficit levels. Conclusions HGS and SLJ showed distinct metric-dependent associations with hypertension. SLJ associations were consistent across the four expressions, whereas HGS associations changed in direction. SLJ/weight, yielded the largest estimates. These findings support the consideration of SLJ along with HGS in pediatric cardiovascular research and highlight the need for clear body size scaling.