Objective:To develop hemoglobin (Hb) percentiles and thresholds for defining anemia among infants aged 0-5 months in China. Methods:The National Nutrition and Health Systematic Survey for children aged 0 -17 years in China, a nationwide cross-sectional study, was conducted between 2019 and 2021. Hb levels were measured in infants using the HemoCue 201+ analyzer. Age- and sex-specific Hb distributions were constructed for "healthy infants", defined as those with adequate iron reserves at birth, exclusive breastfeeding, normal weight-for-age Z-score and weight growth velocity, normal neuropsychological development, and absence of acute or chronic diseases. A generalized additive model for location, scale, and shape was applied to fit the Hb percentiles. The 5th percentile of the Hb distribution was defined as the threshold for anemia. Results:A total of 10,174 infants aged 0-5 months participated in the study, among whom 2,155 healthy infants were included in the analysis. Hb levels peaked at birth, gradually decreased to a nadir around 60 days after birth, and then rose to a plateau. The Hb thresholds defining anemia were 102.7 g/L, 96.3 g/L, 92.8 g/L, 95.4 g/L, 97.1 g/L, and 95.8 g/L for the 0-, 1-, 2-, 3-, 4-, and 5-month age groups, respectively. Conclusion:This study establishes hemoglobin thresholds for defining anemia in infants aged 0-5 months based on a nationwide, population-based dataset in China.

The relationship between screen exposure and early childhood development requires further investigation, especially regarding the age at screen onset, daily screen duration, and potential gender-specific vulnerabilities. This study explored the associations between screen exposure before the age of two and domain-specific developmental outcomes, with particular emphasis on to age of onset, daily exposure duration, and gender differences. This cross-sectional study was conducted as part of the China National Nutrition and Health Systematic Survey for Children Aged 0–17 Years (CNHSC, 2019–2021). A total of 4617 children under the age of two were included. Parents reported their children’s screen exposure history, and developmental outcomes were assessed using the China Development Scale for Children (CDSC, WS/T580-2017). Propensity score matching was applied to minimize potential confounding and selection bias. Three-level linear mixed-effects models were used to assess associations with age at onset, daily screen time, and gender interactions. Among participants (49.7

Introduction Handgrip strength (HGS) is an important indicator of muscular strength in children and adolescents. A Body Shape Index (ABSI) reflects central adiposity-related body shape, but its association with HGS in pediatric populations remains unclear. Methods This cross-sectional study included 6,129 Chinese children and adolescents aged 7–17 years from a national nutrition and health survey. HGS was measured using an electronic dynamometer. ABSI was calculated from waist circumference, height, and BMI and standardized as ABSI_Z. Multivariable linear regression, interaction, and stratified analyses were performed. Results ABSI was negatively correlated with HGS ( r = -0.255, P < 0.001), whereas BMI was positively correlated with HGS ( r = 0.524, P < 0.001). After adjustment for age, sex, height, and BMI, higher ABSI_Z was independently associated with lower HGS (coefficient: -0.47; 95% CI: -0.60, -0.33; P < 0.001). The inverse association was stronger in boys and older age groups (both P for interaction < 0.001). Conclusions Among Chinese children and adolescents, higher ABSI_Z was independently associated with lower HGS after adjustment for BMI and other covariates. These findings suggest that ABSI_Z may capture central adiposity-related body shape characteristics that are adversely associated with handgrip strength during growth and development.

Objectives: The objective of this study was to investigate the association between yogurt consumption and body fat percentage among Chinese children and to analyze the potential influence of factors such as sex, pubertal stage, and physical activity level on this association. Methods: This study conducted a nationwide survey using multi-stage stratified random sampling, including 48,305 children aged 6-17 years. Body fat percentage (BFP) was measured using bioelectrical impedance analysis (BIA). Daily yogurt consumption was adjusted using the density method (daily yogurt consumption = daily yogurt consumption × 1000/total energy consumption). The association between yogurt consumption and body fat percentage was analyzed using quantile regression, with covariates adjusted for participants' age, pubertal development stage, geographical region, total daily energy consumption, physical activity duration, annual household income, parental educational attainment, and consumption of other food categories. Results: Boys aged 6-10 years, 11-14 years, and 15-17 years had median daily yogurt consumptions of 28.6 g, 28.6 g and 21.4 g per day, with BFP values of 19.6, 19.5 and 17.5. Girls in the same age groups showed consumption of 28.6 g, 29.6 g and 28.6 g, with BFP values of 20.3, 26.4 and 31. The quantile regression results for boys showed that daily consumption of yogurt was significantly correlated with their BFP at the 0.25, 0.50, 0.75, 0.85 and 0.95 quartiles, with regression coefficients of -0.207, -0.300, -0.688, -0.570, and -0.465 after adjusting for potential confounders. For girls, there was a significant correlation in the 0.75 and 0.85 quartiles, with regression coefficients of -0.290 and -0.582, after adjusting for potential confounders. Conclusions: A significant inverse association was observed between yogurt consumption and body fat percentage, with notable differences between boys and girls. Further intervention studies are warranted to evaluate the long-term effects of incorporating yogurt into the diets of Chinese children and adolescents on body fat percentage and obesity risk.

Objective:This study aimed to describe 24-hour movement behaviors, including physical activity, sedentary behavior, and sleep period, among Chinese preschoolers using nationally representative data, and examine disparities by age, gender, and residence. Methods:A cross-sectional analysis was conducted using data from the China National Nutrition and Health Systematic Survey for Children (2019-2021), including 10,935 children aged 3-5 years. Daily total time of physical activity (TPA), total time of sedentary behaviors (TSB), and total sleep period (TSP) was collected via validated structured questionnaires. Physical inactivity was defined as < 180 minutes of TPA per day. Results:Median TPA was 121.4 ( IQR: 71.4-209.6) minutes/day, and TSB was 231.4 ( IQR: 175.0-304.3) minutes/day, with 11.46 ± 1.00 hours/day average TSP. Overall, 68.8% were physically inactive, with higher prevalence in rural (73.3%) versus urban areas (64.8%, P < 0.001). TPA and TSB increased with age, while TSP decreased (all P < 0.001). No significant gender differences were observed. Conclusion:Most Chinese preschoolers exhibit insufficient physical activity and excessive sedentary behaviors, with notable urban-rural disparities and an escalating trend of ageing. Continuous monitoring and targeted interventions, especially in rural areas, are urgently needed.

With the rapid aging of China's population, the number of adults aged ≥ 80 years is rising, and their nutritional status and weight management have attracted growing attention. Body mass index (BMI) is a commonly used indicator for assessing body weight and nutritional status. However, existing BMI standards were mainly developed for the general adult population, and their applicability to the oldest old population remains uncertain. To provide guidance for BMI evaluation and weight management among the oldest old population in China, the National Health Commission issued the standard " Appropriate body mass index range and weight management standards for the oldest old (WS/T 868-2025)". Based on evidence from prospective cohort studies including the Chinese Longitudinal Healthy Longevity Survey and the Healthy Aging and Biomarkers Cohort Study, the standard recommends an appropriate BMI range of 22.0-26.9 kg/m 2 for adults aged ≥ 80 years and provides recommendations regarding BMI measurement, weight monitoring, and individualized weight management. The implementation of this standard provides scientific evidence for weight evaluation and health management in the oldest old population and contributes to promoting healthy aging.

BACKGROUND:Selenium is essential for children's health and either deficiency or excess could pose serious health risks. However, nationwide data on selenium nutrition in Chinese children are still lacking, as current studies were primarily limited to historically deficient regions affected by Keshan disease and Kashin-Beck disease. OBJECTIVES:This study aims to investigate the relationship between the living environment, geographic factors, dietary intake, and the selenium status of Chinese children aged 3-17 y. METHODS:Data were derived from the National Nutrition and Health Systematic Survey for children aged 0-17 y (CNHSC), conducted between 2019 and 2021. Field surveys were conducted to collect general demographic information, and a food frequency questionnaire was used to assess dietary intake. Blood selenium concentrations were measured using inductively coupled plasma mass spectrometry (Agilent 7700x), with a cutoff value of 70 μg/L indicating inadequate selenium status. RESULTS:The results revealed that the blood selenium concentration of children aged 15-17 y (92.93 μg/L) was higher than that of other age groups. Additionally, children from rural western areas, with a selenium concentration of 83.28 μg/L, were significantly more vulnerable to inadequate selenium status compared with those from eastern cities [odds ratio (OR) = 20.56 (10.77-39.25)]. Dietary intake of dairy products [OR = 0.58 (0.44-0.75)], meats [≥7 times/wk: OR = 0.48 (0.36-0.64), 3-7 times/wk: OR = 0.65 (0.48-0.90)], and aquatic products [OR = 0.53 (0.37-0.75)] were identified as protective factors against inadequate selenium status (P < 0.001). CONCLUSION:This study suggests that children in rural western areas may be a priority population for future interventions to improve selenium status. A moderate increase in the consumption of selenium-rich foods, such as dairy products, meats, and aquatic products, is recommended to reduce the prevalence of inadequate selenium status in these regions.

OBJECTIVE:To provide updated prevalence and associated factors of double burden of malnutrition(DBM) among children aged 6-17 months in China. METHODS:This study was a cross-sectional study. A multi-stage stratified randomized sampling method was used to recruit 25 791 children aged 6-71 months from 14 provinces in China between 2019 and 2021. A standardized questionnaire survey was used to collect basic information about children and their parents. All children were weighted using unified digital weight scales, and the length/height of all children was determined using unified instruments. Hemoglobin of all children was collected using a HemoCue 201+ system. The body mass index for age Z-scores and anemia were determined and used to evaluate the prevalence of double burden of overweight/obesity and anemia malnutrition. The chi-square test was used to compare the prevalence of malnutrition among children with different characteristics. The unconditional logistic regression model was used to examine factors associated with the malnutrition. RESULTS:This study included 25 791 children aged 6-71 months, including 5127 children aged 6-11 months, 6592 children aged 12-23 months, 3605 children aged 24-35 months, 3492 children aged 36-47 months, 3559 children aged 48-59 months, and 3416 children aged 60-71 months. The prevalence of double burden of overweight/obesity and malnutrition among children aged 6-71 months was 0.8%(n=210).12-23 months(OR=0.69, 95%CI 0.42-0.83), 24-35 months(OR=0.33, 95%CI 0.19-0.55), 36-47 months(OR=0.14, 95%CI 0.06-0.30), 48-59 months(OR=0.26, 95%CI 0.14-0.48), 60-71 months(OR=0.46, 95%CI 0.28-0.75), father&apos;s age of 40-44years(OR=0.40, 95%CI 0.17-0.97) and higher education levels of father(OR=0.40, 95%CI 0.17-0.97) were the protective factors for DBM(P&lt;0.05), whereas large-for-gestational-age infants(LGA)(OR=1.73, 95%CI 1.13-2.66), non-only-child(OR=1.58, 95%CI 1.14-2.19), central regions(OR=1.64, 95%CI 1.11-2.43) and rural area(OR=1.45, 95%CI 1.05-2.00)were the risk factors for DBM(P&lt;0.05). CONCLUSION:The prevalence of DBM among children aged 6-71 months in 14 provinces in China was at a relatively low level. The occurrence of overweight/obesity and anemia malnutrition was impacted by children age, LGA, non-only-child, age of father, education levels of father and regions.

What is already known about this topic?:Micronutrient deficiencies in children represent a significant global health challenge. Currently, there are limited nationally representative reports on micronutrient deficiencies among Chinese children and adolescents. What is added by this report?:This study presents nationally representative data on six micronutrient deficiencies. Among children and adolescents aged 3-17 years in China, the overall prevalence of vitamin A deficiency, marginal vitamin A deficiency, vitamin D deficiency, vitamin D insufficiency, iron deficiency, zinc deficiency, low selenium status, and copper deficiency were 0.3%, 12.1%, 23.9%, 41.2%, 10.9%, 3.3%, 7.1%, and 1.6%, respectively. What are the implications for public health practice?:Among children and adolescents aged 3-17 years in China, vitamin D deficiency in adolescents (12-17 years), iron deficiency in adolescent girls (12-17 years), and low selenium status in rural areas emerge as the most prevalent micronutrient deficiencies requiring targeted interventions.

OBJECTIVE:To explore the relationship between feeding patterns and physical growth of late preterm infants with 34-36 weeks of gestational age and 0-5 months of correction age. METHODS:The data were from the project "Nutrition and Health System Survey and Application for Children aged 0-18 Years in China". Multi-stage stratified random sampling was used to conduct the study at 28 survey sites in 7 regions of East China, North China, Central China, South China, Southwest, Northwest and Northeast China from February 2018 to January 2020. A self-designed structured questionnaire for infants aged 0-6 months was used by the investigators to ask infant mothers or other primary guardians face-to-face to retrospectively collect the basic characteristics and feeding status of infants, and measure the length, weight and head circumference of infants. Based on inclusion criteria and exclusion criteria, a total of 48 late preterm infants fed exclusively breastmilk and 53 late preterm infants fed formula aged 0-5 months of correction age were enrolled in this study. Using the corrected age and gender of late preterm infants fed exclusively breastmilk as matching variables, 48 full-term infants fed exclusively breastmilk aged 0-5 months were matched by propensity score as reference to evaluate the difference in growth and development between late preterm infants and full-term infants fed exclusively breastmilk. Z-scores and weight gain rate were used to evaluate the growth and development of infants. ANOVA was used to compare the growth and development of infants in the three groups. Multiple linear regression was used to adjust for potential confusing factors to analyze the effects of different feeding patterns on the growth and development of late preterm infants. RESULTS:There was no significant difference in length for age Z-score(LAZ), weight for age Z-score(WAZ), weight for height Z-score(WLZ), body mass index for age Z-score(BAZ) and weight gain rate between late preterm infants fed exclusively breastmilk and late preterm infants fed formula(P&gt;0.05), and there was also no significant difference between late preterm infants fed exclusively breastmilk and full-term infants fed exclusively breastmilk(P&gt;0.05). However, The WAZ and head circumference for age Z-score(HCZ) of late preterm infants fed formula were 0.41(P=0.03) and 0.44(P=0.02) higher than those of full-term infants fed exclusively breastmilk, but there was no significant difference in LAZ, WLZ, BAZ and weight gain rate between the two groups(P&gt;0.05). CONCLUSION:At 0-5 months of correction age, the growth and development of late preterm infants fed exclusively breastmilk were similar to that of full-term infants fed exclusively breastmilk. Formula supplementation may promote weight gain, but not length in late preterm infants.

OBJECTIVE:To explore the current status of dietary fiber intake in Chinese children and adolescents. METHODS:Using the data from the 2019-2021 China Nutrition and Health System Survey for Children Aged 0-18, 6116 school-age children from 28 rural and urban survey sites in 14 provinces of China were recorded for their food intake using a continuous 3-day 24-hour dietary review method, and their dietary fiber intake was calculated based on the Chinese Food Composition Table. RESULTS:The median dietary fiber intake for school-aged children aged 6-17 was 7.30 grams per day, and the energy standardized intake was 3.41 grams per 1000 calories. The dietary fiber intake of urban children(3.66 g/1000 kcal) is higher than that of rural children(3.21 g/1000 kcal), and the difference is significant(P&lt;0.05). However, only 8.68% of school-age children aged 6-17 have reached the recommended dietary fiber intake, with urban boys aged 9-11(16.46%) having the highest intake and rural boys aged 6-8(5.41%) having the lowest. CONCLUSION:The dietary fiber intake of school-age children and adolescents in China is insufficient, especially in rural areas and younger age groups.

Purpose: The aims of this study were to explore the differences in total body water and hydration status among Chinese children aged 6–17 years. Methods: A cross-sectional study was implemented among children aged 6–17 years in China. The total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were determined by bioelectrical impedance analysis (BIA). The participants were divided according to age—age 6–8 years, age 9–11 years, age 12–14 years, age 15–17 years—and body mass index (BMI) of China—underweight, normal weight, overweight, and obese groups. The differences of variables of groups were compared using analysis of variance, Student’s t-test, and Kruskal–Wallis test. Significance levels were set at 0.05 (p < 0.05). Results: A total of 59,643 participants (30,103 males and 29,540 females) completed the study. As children became older, the TBW, ICW, ECW, ICW/TBW, and TBW/FFM (TBW to fat free mass ratio) increased simultaneously (all p < 0.05); concurrently, the ECW/TBW decreased with age (all p < 0.05). Boys had higher TBW, ICW, ECW, ICW/TBW, TBW/BW, and TBW/FFM than those of girls at each age (all p < 0.05). For all BMI groups, increases in TBW, ICW, ECW were observed from the underweight group to the obese group, both in boys and girls (all p < 0.001). For the increase in BMI in all age groups, the values of TBW made a significantly lower percentage compared to BW. The higher BMI groups showed higher levels of TBW/FFM, both in girls and boys (all p < 0.001). Conclusions: The body water contents of children aged 6–17 years varied according to their age, sex, and BMI. Overweight and obese individuals may have inferior hydration status compared to those with normal weight.

OBJECTIVE:This study aimed to investigate the prevalence of brachydactyly type A3 (BDA3) and its associated epiphysial development abnormalities in Chinese children aged 3-17 years, and to explore differences based on gender, region and urban-rural demographics. DESIGN:Cross-sectional study. SETTING:The study was conducted across 14 provinces (28 survey sites) in China, as part of a nationwide investigation on skeletal maturation. The population was selected using multistage stratified randomised cluster sampling. PARTICIPANTS:A total of 17 850 children (8856 boys and 8994 girls) aged 3-17 years participated. The cohort was drawn from a large-scale survey conducted between 2019 and 2021. Selection criteria included children with no visible clinodactyly or hand function impairments. METHODS:Non-dominant hand-wrist radiographs were obtained using a portable X-ray device. A retrospective analysis of these radiographs was performed to identify BDA3 and epiphysial development abnormalities. Prevalence rates were calculated and compared across gender, regional and urban-rural groups. RESULTS:The overall prevalence of BDA3 was 10.0%, with a higher prevalence in girls (12.9% vs 7.1%; p<0.001). The northern region exhibited a higher prevalence compared with the southern region (11.5% vs 8.6%; p<0.001). No significant differences were observed between urban and rural areas (10.3% vs 9.8%; p=0.32). Among the BDA3 phenotypes, brachymesophalangia-5 with cone-epiphysis of mid-5 (BMP5) and BMP5 alone had prevalences of 3.6% and 6.4%, respectively. Both phenotypes were more common in girls compared with boys (p<0.001 for both). CONCLUSIONS:This nationwide, multicentre study provides the first national epidemiologic data on BDA3 and associated epiphysial features in Chinese children and adolescents, establishing a prevalence of 10.0%. This baseline supports counselling that a straight, well-functioning short fifth finger is a common anatomic variant and may help reduce unnecessary concern.

We aimed to investigate the associations between dietary choline, its subtypes, and cognitive function in older adults from underdeveloped regions of China, using data from the Nutrition and Chronic Disease Family Cohort (NCDFaC) study. This cross-sectional study included 1 522 older adults aged 60 and over. Dietary choline intakes were assessed using a food frequency questionnaire, and cognitive function was evaluated with the Mini-Mental State Examination (MMSE). The associations between choline intake and mild cognitive impairment (MCI) were analyzed using logistic regression models, restricted cubic splines and propensity score matching (PSM). Among the 1 522 participants, 292 (19.2

What is already known about this topic?:The prevalence of hypertension in children and adolescents is increasing, which is closely associated with cardiovascular disease risk in adulthood. The Dietary Approaches to Stop Hypertension (DASH) has demonstrated effectiveness in reducing blood pressure in adults. However, limited evidence exists regarding its effects among children in China. What is added by this report?:This cross-sectional study found that 15.4% of Chinese children and adolescents aged 7 to 17 years had elevated blood pressure. The median DASH score was 24 [interquartile range (IQR) 21-28]. Students with higher DASH scores demonstrated a lower prevalence of elevated blood pressure compared to those with lower scores. What are the implications for public health practice?:DASH adherence was inversely associated with elevated blood pressure prevalence among students aged 7-17 years in China. Increasing adherence to the DASH dietary pattern could play an effective role in the prevention and management of hypertension among children and adolescents.

BACKGROUND:Evidence suggested that abiotic airborne exposures may be associated with changes in body composition. However, more evidence is needed to identify key pollutants linked to adverse health effects and their underlying biomolecular mechanisms, particularly in sensitive older adults. OBJECTIVES:Our research aimed to systematically assess the relationship between abiotic airborne exposures and changes in body composition among healthy older adults, as well as the potential mediating mechanisms through the serum lipidome. METHODS:From September 2018 to January 2019, we conducted a monthly survey among 76 healthy adults (60-69 years old) in the China Biomarkers of Air Pollutant Exposure (BAPE) study, measuring their personal exposures to 632 abiotic airborne pollutions using MicroPEM and the Fresh Air wristband, 18 body composition indicators from the InBody 770 device, and lipidomics from venous blood samples. We used an exposome-wide association study (ExWAS) and deletion/substitution/addition (DSA) model to unravel complex associations between exposure to contaminant mixtures and body composition, a Bayesian kernel machine regression (BKMR) model to assess the overall effect of key exposures on body composition, and mediation analysis to identify lipid intermediators. RESULTS:The ExWAS and DSA model identified that 2,4,5-T methyl ester (2,4,5-TME), 9,10-Anthracenedione (ATQ), 4b,8-dimethyl-2-isopropylphenanthrene, and 4b,5,6,7,8,8a,9,10-octahydro-(DMIP) were associated with increased body fat mass (BFM), fat mass indicators (FMI), percent body fat (PBF), and visceral fat area (VFA) in healthy older adults [Bonferroni-Hochberg false discovery rate (FDRBH)<0.05]. The BKMR model demonstrated a positive correlation between contaminants (anthracene, ATQ, copaene, di-epi-α-cedrene, and DMIP) with VFA. Mediation analysis revealed that phosphatidylcholine [PC, PC(16:1e/18:1), PC(16:2e/18:0)] and sphingolipid [SM, SM(d18:2/24:1)] mediated a significant portion, ranging from 12.27% to 26.03% (p-value <0.05), of the observed increase in VFA. DISCUSSION:Based on the evidence from multiple model results, ATQ and DMIP were statistically significantly associated with the increased VFA levels of healthy older adults, potentially regulated through lipid intermediators. These findings may have important implications for identifying potentially harmful environmental chemicals and developing targeted strategies for the control and prevention of chronic diseases in the future, particularly as the global population is rapidly aging. https://doi.org/10.1289/EHP13865.

Objective: The aim of this study was to explore the relationship between breastfeeding duration and neurodevelopment in children aged 2 to 3 years in a Chinese population. Methods: This study was based on a cross-sectional survey. The data were from the National Nutrition and Health Systematic Survey for children in China which was conducted from 2019 to 2020. Characteristics of parents and children and the breastfeeding duration were obtained using interview-administered questionnaires. Children's neuropsychological development was assessed by a trained child health care physician using the Child Psychological Development Scale. A multivariable linear regression model was used to analyze the association between breastfeeding duration and neuropsychological development. Results: A total 1290 children aged 2-3 years were included in the present analysis. In multivariable linear regression models, after adjustment for potential confounders, children who were breastfed for 7-12 months had a 3.59-point increase in gross motor development ((3 = 3.59; 95% confidence interval [CI]: 1.23 to 6.34), a 3.73-point increase in fine motor development ((3 = 3.73; 95 % CI: 1.09 to 6.47), and a 2.87-point in language development ((3 = 2.87; 95 % CI: 1.12 to 5.31) compared with those who were never breastfed. Children who were breastfed for > 12 months had a 3.77-point increase in fine motor development ((3 = 3.77; 95 % CI: 0.98 to 6.86) compared with those who were never breastfed. Conclusions: Longer breastfeeding duration was associated with increased gross motor, fine motor, and language scores in our study population. Mothers in China should be encouraged to initiate and continue breastfeeding.