The objective of this study was to develop a Chinese Healthy Eating Index (CHEI) based on the updated Dietary Guidelines for Chinese (DGC-2016) and to apply it in the 2011 China Health and Nutrition Survey (CHNS-2011) to assess diet quality and its association with typical sociodemographic/economic factors. Data from 14,584 participants (≥2 years) from the CHNS-2011, including three 24-h dietary recalls and additional variables, were used to develop the CHEI. The standard portion size was applied to quantify food consumption. The CHEI was designed as a continuous scoring system, comprising 17 components; the maximum total score is 100. The mean, 1st and 99th percentiles of the CHEI score were 52.4, 27.6 and 78.3, respectively. Young and middle-aged adults scored better than the elderly. Diet insufficiency was chiefly manifested in fruits, dairy, whole grains and poultry; diet excess was mainly reflected in red meat, cooking oils and sodium. The CHEI was positively associated with education and urbanization levels; current smokers and unmarried people obtained relative low CHEI scores. Occupation and body mass index (BMI) were also related to the CHEI. Our findings indicate that the CHEI is capable of recognizing differences in diet quality among the Chinese, and it is sensitive to typical sociodemographic/economic factors.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Hospital-based health promotion resources to assist pregnant women in achieving healthy lifestyle and optimizing gestational weight gain (GWG) is important, but with limited effects. Increasingly, women are using mobile applications (apps) to access health information during the antenatal period. Objective: This study aimed to have a better understanding of the use of mobile apps for health information among Chinese women during pregnancy and to inform the development of health promotion program through an app. Methods: A mixed methods study design was applied. Study participants were recruited from two maternity hospitals in Shanghai, China between March and July 2018. A self- administered online survey was conducted with 535 Chinese pregnant women on their sources of health information and reasons for using apps during pregnancy. Four semi-structured focus groups were also conducted with pregnant women (n = 28). Results: The use of pregnancy related apps and internet were common among the respondents. Almost half of women had used pregnancy related apps. Specifically, the use of app for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reasons of using an app were for monitoring foetal development (81.5%, 436/535) followed by learning nutrition and recording diet in pregnancy (26.2%,140/535). Women found the apps were useful and convenient for promoting lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information which could cause anxiety. Many women expressed the need of developing an app containing evidence-based, well-informed and tailored health information to support them during pregnancy. Conclusions: Smartphone apps have the potential to deliver health information, but they can also cause negative impact on women with misinformation. Efforts should be made by health professionals, app developers and policy makers to ensure quality apps to be developed for providing timely health promotion information. The apps can be intergraded into maternal care to meet the needs of pregnant women.

Environmental exposure to cadmium causes renal dysfunction and bone damage. Cadmium contamination in food is regarded as the main environmental source of non-occupational exposure. The aim of this study was to assess the contribution of dietary cadmium exposure in environmental cadmium exposure and its health risk among adults in Shanghai, China. A cross-sectional survey about food consumption was conducted in 2008 among 207 citizens aged over 40 years in Shanghai, China. The food frequency questionnaire was combined with food, tobacco and water cadmium exposure to estimate the daily environmental cadmium exposure in both point and probabilistic estimations. Urine and blood samples of the participants were analyzed for internal exposure to total cadmium. Correlation analysis was conducted between the internal cadmium exposure and environmental cadmium exposure. According to the point estimation, average daily environmental cadmium exposure of the participants was 16.7 μg/day and approached 33.8% of the provisional tolerable daily intake (PTDI). Dietary and tobacco cadmium exposure approached 25.8% and 7.9% of the PTDI, respectively. Males had higher levels of dietary cadmium exposure than females (p?=?0.002). The probabilistic model showed that 93.4% of the population did not have any health risks from dietary cadmium exposure. By sensitivity analysis, tobacco consumption, tobacco cadmium level, cadmium in vegetables and cadmium in rice accounted for 27.5%, 24.9%, 20.2% and 14.6% of the total cadmium exposure, respectively. The mean values of urinary and blood cadmium among the study population were 0.5 μg/L and 1.9 μg/L, respectively. Positive correlations were observed between environmental cadmium exposure and blood cadmium (R?=?0.52, P<0.01), tobacco cadmium intake and blood cadmium excluding non-smokers (R?=?0.26, P?=?0.049<0.05), and urine cadmium and age (R?=?0.15, P?=?0.037). It has been suggested that there is no increased health risk among adult residents in Shanghai, China because of recent total cadmium exposure. Vegetables and rice were the main sources of dietary cadmium intake. Tobacco cadmium exposure, which accounted for approximately 25% of the total dietary cadmium exposure, was another important source of non-occupational cadmium exposure.

Dysphagia, or swallowing difficulty, is a common morbidity affecting 10% to 33% of the elderly population. Individuals with dysphagia can experience appetite, reduction, weight loss, and malnutrition as well as even aspiration, dehydration, and long-term healthcare issues. However, current therapies to treat dysphagia can routinely cause discomfort and pain to patients. To prevent these risks, a non-traumatic and effective treatment of diet modification for safe chewing and swallowing is urgently needed for the elderly. This review mainly summarizes the chewing and swallowing changes in the elderly, as well as important risk factors and potential consequences of dysphagia. In addition, three texture-modified food processing strategies to prepare special foods for the aged, as well as the current statuses and future trends of such foods, are discussed. Nonthermal food technologies, gelation, and 3D printing techniques have been developed to prepare soft, moist, and palatable texture-modified foods for chewing and swallowing safety in elderly individuals. In addition, flavor enhancement and nutrition enrichment are also considered to compensate for the loss of sensory experience and nutrients. Given the trend of population aging, multidisciplinary cooperation for dysphagia management should be a top priority.

Background: Excessive gestational weight gain (GWG) poses negative impact on mothers and their children. It is important to understand the modifiable lifestyle factors associated with excessive GWG during pregnancy to guide future public health practice. Aim: To investigate the association between physical activity during pregnancy and GWG of Chinese urban pregnant women. Methods: A pregnant women cohort was established between 2005 and 2007 in Changzhou, China. Physical activity levels of pregnant women were assessed using pedometer in the 2^nd and 3^rd trimester, respectively. According to step counts, pregnant women were categorized into 4 different physical activity groups: Sedentary, Low Active, Somewhat Active and Active. The pregnant women were followed for eligibility and data collection from the 2^nd trimester to delivery. Multiple linear regression and multiple binary logistic model were applied to determine the association between physical activity and GWG. Results: Physical activity levels and GWG of 862 pregnant women were assessed, among them 473 (54.9%) experienced excessive GWG. The adjusted odds ratio (OR) was 0.59 (95%CI: 0.36 ~ 0.95) for excessive GWG in the Active group during the 2^nd trimester and 0.66 (95%CI: 0.43 ~ 1.00) in the Somewhat Active group during the 3^rd trimester, compared with the Sedentary group respectively. In the last two trimesters, the Active group had 1.45 kg less GWG, than the Sedentary group. The ORs of excessive GWG decreased with the increased level of physical activity (P < 0.05). Conclusion: This study suggests that pregnant women being physically active have less weight gain during pregnancy.