Background: The co-occurrence of obesity and elevated blood pressure (EBP) in childhood represents a critical but underrecognized public health concern, with potential long-term consequences for cardiometabolic health. Understanding its trends and disparities is essential for early prevention strategies. Methods: This study analyzed data from 1,692,660 Han Chinese children and adolescents aged 7–18 years collected across seven waves of the Chinese National Survey on Students’ Constitution and Health (CNSSCH) from 1985 to 2019. Joinpoint regression was used to estimate temporal trends, and logistic generalized additive models were fitted to predict prevalence through 2030. Results: The prevalence of co-occurring obesity and EBP increased from 0.06% in 1985 to 2.36% in 2019 and is projected to reach 5.87% by 2030. A slowdown in the growth rate was observed approximately in 2000. Notably, rural areas experienced a faster and more recent rise, especially among girls, suggesting widening disparities. Conclusions: The growing dual burden of obesity and EBP in Chinese youth, especially in rural areas, calls for urgent and integrated interventions. Public health efforts must prioritize early prevention, with equitable policies that engage schools, families, and communities, particularly in underserved populations.

Secondary education, and early marriage and childbirth are major determinants of health and wellbeing. We aimed to describe the long-term trends and inequalities of these three indicators in Chinese adolescents over three decades of dramatic social and economic change. Using data from Chinese population censuses and 1% population sample surveys from 1990 to 2020 (the most recent survey), we calculated the senior secondary school participation rate in 20–24-year-olds, the ever-married rate in 15–19-year-olds, and the age-specific fertility rate in 15–19 year-old females, by urban-rural location and province. In urban areas, the secondary school participation rate substantially increased, from 34.7% in 1990 to 82.4% in 2020 for females and from 38.7% to 77.0% for males. The participation rate in rural areas also greatly increased, from 5.0% in 1990 to 55.7% in 2020 for females and from 9.1% to 51.0% for males, but remained markedly lower than in urban areas at all time points. The ever-married rate decreased dramatically from 1990 to 2005, rebounded between 2005 and 2015, and then dropped so that the rate in 2020 was at a level comparable to that in 2005 (0.7% [95% CI 0.7–0.7] for urban females, 2.2% [2.1–2.2] for rural females, 0.2% [0.2–0.2] for urban males, and 0.5% [0.5–0.5] for rural males). In urban areas, the fertility rate decreased from 10.1 per 1000 in 1990 to 2.4 (2.3–2.4) per 1000 in 2000, but then largely stabilised between 2000 and 2020. For rural adolescents, the fertility rate also decreased dramatically from 25.9 per 1000 in 1990 to 8.5 (8.2–8.8) per 1000 in 2005. The fertility rate rebounded to 15.4 (14.9–15.9) per 1000 in 2015 and decreased to 12.5 (12.3–12.7) in 2020 in rural areas. These three indicators greatly varied by province in 2020, with more negative patterns in western provinces. China has seen dramatic changes in adolescent education, and early marriage and fertility over the past three decades but large inequities persist between urban-rural areas and by province. Government investments are needed to promote education in rural areas and western regions to promote more equitable health, development and wellbeing in Chinese adolescents. 10.13039/501100001809 National Nature Science Foundation of China .

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: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased rapidly in pediatric populations. Evidence on the cost-effectiveness of pediatric MASLD screening strategies remains limited. Methods: A decision tree combined with a Markov state-transition model was developed to evaluate the cost-effectiveness of three WHtR-based two-stage screening strategies among children aged 6–14 years in Beijing, China: WHtR combined with ultrasound (S1), WHtR combined with FibroScan^® (S2), and WHtR combined with magnetic resonance imaging-proton density fat fraction (MRI-PDFF) (S3), compared with no screening (S4). All screening strategies were combined with lifestyle modification programs, including dietary and exercise management. Model inputs were derived from the published literature, national survey data, and expert consensus. Costs and quality-adjusted life years (QALYs) were estimated from a healthcare system perspective over a 10-year time horizon, with a 3% annual discount rate. Incremental cost–utility ratios (ICURs) were calculated, and extensive one-way, two-way, and probabilistic sensitivity analyses were performed. Results: Our model indicated that, at a willingness-to-pay (WTP) threshold of $30,584.0 per QALY, corresponding to three times the gross domestic product (GDP) per capita of China, S2 was identified as the optimal strategy. At a higher WTP threshold of $71,415.5 per QALY, based on the GDP per capita of Beijing, S3 became the most cost-effective option. All three screening strategies were more cost-effective than no screening across both thresholds. Sensitivity analyses demonstrated that utility values for fibrosis stages and the response rate of the lifestyle modification program were the most influential parameters, and probabilistic sensitivity analysis confirmed the robustness of the baseline findings. Conclusions: To the best of our knowledge, this is the first cost-effectiveness analysis for pediatric MASLD in China. Model-based estimates suggest that early screening for MASLD in children using WHtR-based screening strategies is cost-effective, with FibroScan^® preferred in settings with average economic development and MRI-PDFF preferred in more affluent regions. These findings underscore the importance of context-specific implementation of early MASLD screening strategies in pediatric populations to mitigate long-term disease burden.

Background/Objectives: The potential of outdoor physical activity as an intervention strategy to promote height growth velocity via stimulating growth hormone secretion and vitamin D synthesis has been scarcely investigated. The present study aimed to investigate the associations between outdoor physical activity duration and height growth velocity, and differences in gender, age, exposure time period (daily, school days vs. weekends), and body mass index (BMI) category. Methods: We performed a secondary analysis of longitudinal data from the 2019–2020 Chinese National Survey on Students’ Constitution and Health. The analytic sample included 5029 adolescents aged 9–18 years. High or low height growth velocity was defined as sex- and age-specific percentiles. Associations of high height growth velocity with outdoor activity duration (≥1 h, ≥2 h) on school days and weekends were investigated using multivariable logistic regression models. Analyses were stratified by sex, age group (9–12, 13–15, 16–18 years), and BMI category (normal weight, overweight, and obese). Results: Results from this cross-sectional analysis indicate that ≥1 h of daily outdoor physical activity is significantly associated with higher height growth velocity among normal-weight boys aged 9–15 years (OR range: 1.71–2.01) and girls aged 9–12 years (OR = 1.68). The positive association increased with ≥2 h (ORs up to 7.96). Consistently positive associations were found for activity during the school day compared to weekends. No significant associations were found in overweight and obese children. Conclusions: Ensuring adequate daily outdoor physical activity—especially on weekends—for at least two hours may be an important potential strategy to promote height growth in normal-weight children and adolescents. Interventions should consider differences in weight status and timing of activity.