Background: The Perceived Stress Scale (PSS) is a globally used and self-report scale measuring perceived stress. Three versions of PSS (PSS-14, PSS-10 and PSS-4) are available which comprise 14, 10 and 4 items respectively. However, the Chinese version of the PSS has not yet been validated in a large community-based general population. The aims of this study were to evaluate the psychometric properties of the Chinese PSS in a large community-based general population and to compare the appropriateness of the three versions of PSS. Methods: A total of 9507 adults with at least a junior high school education and completed PSS-14 from the China Health and Nutrition Survey were involved in this study. The internal consistency reliability of PSS was assessed using Cronbach’s alpha coefficient and confirmatory factor analysis was employed to test the construct validity. Modification index was used for model extension and the critical ratio was used for model restriction. Results: The internal consistency coefficients were satisfactory for PSS-14 and PSS-10, but not for PSS-4. The corresponding Cronbach’s alpha were 0.830, 0.754 and 0.473 respectively. A 2-factor structure was confirmed for the PSS-14 and PSS-10, and all items’ standardized factor loadings exceeded 0.4 for either negative or positive factors. Given that item 12 loaded on both negative and positive factors for PSS-14 and the goodness of fit for PSS-14 was not acceptable, PSS-13 (PSS-14 excluding item 12) was studied. The construct validities of PSS-13 and PSS-10 were satisfactory, but the goodness of fit for PSS-10 were better than that for PSS-13. Conclusions: PSS-13 (PSS-14 excluding item 12) and PSS-10 have satisfactory psychometric properties. PSS-10 are more applicable to measure the perceived stress than PSS-13 in a large community-based general population in China.

Studies on fat intake and obesity have been inconclusive. This study examined the associations between dietary fat intake and body weight and the risk of overweight and obesity in China. We used data from 23,859 adults aged 20–60 years who participated in the China Health and Nutrition Survey, an ongoing open-cohort study, from 1991 to 2015. We collected detailed dietary data by conducting three 24-h dietary recalls and weighing foods and condiments in household inventories. We examined the associations between fat intake and body weight, body mass index (BMI), and the risk of overweight and obesity with random-effects linear or logistic regression models for panel data. The Chinese population’s fat intake, percentage of energy intake from fat, and prevalence of high-fat diets (energy intake from fat > 30%) increased from 68.5 g per day (g/d), 23.1%, and 22.4%, respectively, in 1991 to 79.3 g/d, 35.6%, and 67.2%, respectively, in 2015. The prevalence of overweight and obesity increased from 12.3% to 37.3% during the same period. Fat intake, percentage of energy intake from fat, and a high-fat diet were positively associated with body weight, BMI, and the risk of overweight and obesity in both sexes (p < 0.001) after adjustment for nonfat energy intake, physical activity, and socioeconomic status. Increased fat intake and high-fat diets were associated with increased body weight, BMI, and risk of overweight and obesity. These findings could have a significant impact on Chinese policies and interventions to control overweight and obesity.

Poor dietary habits have been shown to be associated with a range of chronic diseases and can potentially be a major contributor to non-communicable diseases (NCDs) mortality. We therefore aimed to identify the prevailing dietary patterns among Chinese adults and to evaluate trends in dietary patterns from 1991 to 2015. We used data collected in the China Health and Nutrition Survey (CHNS). Dietary patterns were identified using factor analysis of data from three consecutive 24 h dietary recalls. We studied 29,238 adults aged 18 and above with complete demo-graphic and dietary data. Three distinct dietary patterns were identified: southern (high intakes of rice, vegetables, and pork), modern (high intakes of fruits, dairy products, cakes, cookies, and pastries), and meat (high intakes of organ meats, poultry, and other livestock meat). The southern pattern score decreased (mean ± SD scores in 1991: 0.11 ± 1.13; scores in 2015: −0.22 ± 0.93). The modern pattern score (mean ± SD scores in 1991: −0.44 ± 0.59; scores in 2015: 0.21 ± 1.01) and meat pattern score (mean ± SD scores in 1991: −0.18 ± 0.98; scores in 2015: 0.27 ± 0.91) increased. We observed that China has experienced a shift from traditional dietary patterns to western dietary patterns.

The prevalence of childhood overweight and obesity in developed countries appears to be plateauing. The purpose of this study was to provide the most recent data on the prevalence and trends in overweight and obesity among Chinese children and adolescents from 2011 to 2015. We used data collected in the China Health and Nutrition Survey (CHNS) and China Nutritional Transition Cohort Study (CNTCS). We used two waves of the survey in 12 provinces conducted in 2011 (aged 7–18 years; n = 1458) and 2015 (aged 7–18 years; n = 1084) to perform a trend analysis. We used data collected in 15 provinces (aged 7–18 years; n = 1617) to estimate the prevalence of overweight and obesity among Chinese children and adolescents in 2015. In 2015, based on the Working Group for Obesity in China (WGOC) criteria, the prevalence of overweight and obesity were 14.0% (95% CI, 11.6–16.3) and 10.5% (95% CI, 8.4–12.6) in boys, and 9.7% (95% CI, 7.7–11.8) and 7.1% (95% CI, 5.2–8.9) in girls, respectively. The increase in BMI z-scores from 2011 to 2015 was statistically significant among adolescents (p = 0.0083), but not among children. No significant changes were observed in prevalence of overweight and obesity between 2011 and 2015, excepting adolescents aged 12–18 years (p = 0.0086). Since 2011, overweight has remained stable, and obesity has stabilized in children, though not in adolescents. Although levels of childhood overweight and obesity in China are not high compared to other developed countries, they remain concerning enough that effective policies and interventions need to be sustained and intensified for lowering rates of childhood overweight and obesity.

Studies on macronutrient intake and obesity have been inconclusive. This study examined the associations between multi-trajectories of macronutrients and the risk of obesity in China. We used data from 7914 adults who participated in the China Health and Nutrition Survey at least three times from 1991 to 2018. We collected detailed dietary data by conducting three 24 h dietary recalls and weighing foods and condiments in household inventories. We identified multi-trajectories using group-based multi-trajectory models and examined their associations with the risk of obesity with multiple Cox regression models. We found four multi-trajectories in rural areas: balanced macronutrient intake (BM), moderate protein, increasing low fat, and decreasing high carbohydrate (MP&ILF&DHC); decreasing moderate protein, decreasing high fat, and increasing moderate carbohydrate (DMP&DHF&IMC); increasing moderate protein, increasing high fat, and decreasing low carbohydrate (IMP&IHF&DLC)—35.1%, 21.3%, 20.1%, and 23.5% of our rural participant population, respectively. Compared with the BM trajectory, the hazard ratios of obesity in the DMP&DHF&IMC and the IMP&IHF&DLC groups were 0.50 (95% confidence interval (CI): 0.27–0.95) and 0.48 (95% CI: 0.28–0.83), respectively, in rural participants. Relatively low carbohydrate and high fat intakes with complementary dynamic trends are associated with a lower risk of obesity in rural Chinese adults.