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.

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: 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.