Objective: To understand and analyze the current situation and secular trends for prevalence of malnutrition among Chinese children and adolescents aged 7-18 years from 2005 to 2014, and to provide important scientific basis for students' nutrition improvement.Methods: All the subjects aged 7-18 years in both sexes were sampled from 2005, 2010 and 2014 Chinese National Surveys on Students Constitution and Health.According to the new students' health standard of Screening Standard for Malnutrition of school-age children and adolescents(WS/T456-2014) in 2014 of China, the nutritional status of children in 31 provinces (autonomous regions and municipalities, excluding Hong Kong, Macao and Taiwan province) were analyzed and compared in different ages, genders, regions and provinces from 2005 to 2014.The Tibetan students was used with the data of Tibetan minority and all the other students from 30 provinces (autonomous regions, municipalities) were Han minority.Results: The prevalence of malnutrition of children and adolescents of Han minority aged 7-18 years in 2014 was 10.0%.The prevalence of malnutrition components, including stunting, mild wasting and moderate severe wasting, were 0.8%, 3.7%, and 5.5%.Compared with 2005 and 2010, the prevalence of malnutrition of Han children and adolescents in 2014 had declined with 5.0 and 2.6 percentage points, respectively, and its components had declined with 1.0, 1.8, 2.2 and 0.4, 1.1, 1.2 percentage points, respectively.The prevalence of malnutrition of 2014 in boys was higher than in girls (11.1% vs.8.9%), the rural was higher than the urban (11.0% vs.9.1%) and the west (11.7%) was higher than the east (9.0%) and the middle (9.2%).Mild wasting of Chinese children and adolescents aged 7-18 years was the main component in malnutrition and the stunting in the Han and Tibetan children and adolescents only accounted for 8.0% and 7.5%, respectively.Compared with 2005 and 2010, the prevalence of malnutrition for Chinese children and adolescents aged 7-18 years in 2014 had declined with various extents constantly, and there was a statistically significant difference among three surveys (P<0.05).Provinces (autonomous regions, municipalities) with high prevalence of malnutrition mainly concentrated in the southwest of China from 2005 to 2014.Compared with 2005 and 2010, the prevalence of malnutrition declined in 31 provinces (autonomous regions, municipalities) of China in 2014.The number of provinces (autonomous regions, municipalities) with high prevalence of malnutrition decreased constantly and increased for the number of province (autonomous regions, municipalities) with low prevalence.Conclusion: The prevalence of malnutrition among Chinese children and adolescents aged 7-18 years had declined from 2005 to 2014, but the total prevalence of malnutrition was still high.Mild wasting was the main component in malnutrition and the prevalence of stunting was low.Provinces (autonomous regions, municipalities) with high prevalence of malnutrition mainly concentrated in the southwest of China.

Abstract Early environment is associated with children s physical and mental development, personality and social adaptability. Recent studies showed that the early environment such as family structure, parenting style, family socioeconomic status and endocrine disruptors were closely associated with gender role development among children and adolescents. Policy makers and parents should pay attention to the early environment of childhood development, which plays an important role in promoting the healthy development of children s gender role.

Objective: To investigate the endemic distribution and related factors of elevated blood pressure in Chinese children and adolescents aged 7 to 18 years old. Methods: A total of 214 354 students aged 7 to 18 years old with data integrity of height, weight, and blood pressure were selected from Chinese National Survey on Students Constitution and Health in 2014, including 31 provinces (with the exception of Hong Kong, Macao, and Taiwan) in China. The criterion of elevated blood pressure was defined by the diagnosis and treatment guideline of high blood pressure in US children and adolescent. The differences of elevated blood pressure between boys and girls and different groups of nutritional status were calculated by Chi-square test. Results: The mean values of systolic pressure and diastolic pressure were (104.8 ± 12.8) mmHg (1 mmHg=0.133 kPa), and (65.4 ± 9.7) mmHg, respectively. The rate of elevated blood pressure in Chinese children and adolescents aged 7 to 18 years old was 6.4% (13 558/214 354), as well as 7.0% (7 537/106 982) in boys, and 5.7% (6 131/106 979) in girls (P<0.001). Meanwhile, the rate of elevated blood pressure was 3.2% (321/10 127), 4.9% (7 887/161 419), 9.8% (2 472/25 292), and 17.5% (2 988/17 051) in wasting group, normal group, overweight group and obesity group, respectively, which indicated a rising trend from wasting to obesity among four nutritional status groups(P<0.001). Conclusion The rate of elevated blood pressure in Chinese boys was higher than girls, especially in overweight and obese students. Therefore, the effective intervention on child and adolescent with overweight or obesity will become the key work on the prevention of high blood pressure in the future.

Objective: The American Heart Association released the Life s Essential 8 (LE 8) for the overall evaluation of cardiovascular health (CVH) on individual level. The present study aimed to describe the overall CVH in Chinese school aged children using LE 8 metrics. Methods: Data of the present analysis came from a national representative multicentered cross sectional study conducted in 7 provinces of China in 2013. The original study used a multistage cluster sampling method. A total of 10 326 children aged 5 to 19 years with complete data of health behaviors and health outcomes were included in the study. Children s health behavior indicators included diet, physical activity, nicotine exposure and sleep health. Health outcome factors included body mass index, fast blood glucose, lipid profile and blood pressure. Results: The median CVH score was 73.3 ( IQR =14.4) in boys and 73.4 ( IQR = 13.5) in girls. Compared to children aged ≤9 years, the health behavior scores were lowest in the 13-15 age group, with boys scoring 7.73 lower (95% CI =-8.35--7.12, P <0.01) and girls scoring 9.15 (95% CI =-9.83--8.48, P <0.01) lower. The ≥16 age group had the lowest health outcome scores, with boys scoring 7.85 (95% CI =-9.07--6.63, P <0.01) lower and girls scoring 6.11 (95% CI =-7.12--5.09, P <0.01) lower. Conclusions Chinese school aged children are generally at a moderate level of cardiovascular health. Specific LE 8 components vary substantially between groups and therefore require targeted intervention strategies.

Objective: To investigate the prevalence of metabolic syndrome (MS) among children and adolescents aged 10-16 years old in 7 provinces in China. Methods: Using the method of stratified cluster random sampling, 93 primary and secondary schools were selected from Guangdong, Hunan, Liaoning, Shanghai, Chongqing, Tianjin, and Ningxia provinces in China. A total of 9 296 students aged 10-16 years old with complete physical and biochemical parameters were selected as the subjects of the present study from above 93 primary and secondary schools. MS was determined using the definition of 'guideline of 2010 Chinese children and adolescents MS definition and treatment’. The standardized age-sex composition of the 2010 census was used to standardize the MS detection rate of every province. Chi-square test was used to compare the difference of MS prevalence among participants with different characteristics. Results: The prevalence of MS was 4.1% (384/9 296) among children and adolescents aged 10-16 years old in 7 provinces in China. The prevalence of MS among males was 5.0% (237/4 754), which was significantly higher than females (3.2%) (147/4 542) (P<0.05). Stratified by nutrition conditions, the prevalence of MS was 0, 0.6% (39/6 733), 8.9% (104/1 170), 30.0% (241/803) for thin, normal weight, overweight, and obese population, respectively. The MS prevalence increased with the increase of body mass index (BMI) (P<0.001). Stratified by provinces, the prevalence of MS was the highest in Tianjin (9.2%) and the lowest in Hunan province (0.8%). Conclusion The prevalence of MS was high among children and adolescents aged 10-16 years old in 7 provinces in China. MS prevalence among males was higher than females; MS prevalence among overweight/obese population was higher than normal weight population. The detection rate of metabolic syndrome was different in different provinces.

Objective: To investigate the trends in overweight and obesity in Chinese students during 1985-2014. Methods: Data were collected from the Chinese National Survey on Students Constitution and Health in 1985, 1995, 2000, 2005, 2010, and 2014, with the sample size of 409 946, 204 977, 216 786, 234 421, 215 319, and 214 354, respectively. The prevalence of overweight and obesity as well as the increase rates were calculated based on the body mass index (BMI) percentile criteria of Working Group on Obesity in China (WGOC). Results: The prevalence of overweight and obesity in 2014 was 19.4% (41 608/214 354) among 7-18 y Chinese children. The prevalence of overweight and obesity was 24.2% (25 975/107 216) among boys, and 14.6% (15 633/107 138) among girls, with the prevalence among boys exceeding girls (P<0.001). The prevalence of overweight and obesity was 22.3% (23 911/107 239) among urban students, and 16.5% (17 697/107 115) among rural students, with the prevalence among urban students exceeding rural students (P<0.001). The prevalence in 2014 differed among provinces, ranging from 2.3% (Hainan Province 166/7 200) to 16.3% (Tianjin 168/7 186). During 1985-2014, the prevalence of overweight and obesity among 7-18 y Chinese children increased continuously, with the annual increase rate of overweight ranging 0.27%-0.63%, and the annual increase rate of obesity ranging 0.10%-0.58%. The annual increase rates in 2010-2014 of obesity among the urban boys, urban girls, rural boys and rural girls were 0.62%, 0.42%, 0.79%, and 0.49%,respectively, peaking the annual increase rates during 1985-2014. Conclusion The prevalence of overweight and obesity among 7-18 y Chinese children increased continuously during 1985-2014, with the annual increase rate of obesity in 2010-2014 peaking the increase rates during 1985-2014. There were gender and regional differences in the prevalence of overweight and obesity among 7-18 y Chinese children in 2014.

Objective: To explore the relationship between nutritional status and puberty onset in boys, and to provide a reference for promoting the development of physical and mental health of boys. Methods: A total of 2 724 boys aged 7 to 12 years from grade 2 to 6 were recruited from Xiamen city by cluster sampling method in 2017. The nutritional status was assessed by physical examination, pubertal developmental status was evaluated by rating scales of Tanner and Prader orchidometer, and puberty timing was determined by the P25 age of puberty onset. The association between nutritional status and puberty onset was estimated by logistic regression model. Results: Pubertal onset was found in 29.0% of the boys and the incidence of early pubertal timing was 2.9%. The prevalence of puberty onset in wasting, normal weight, overweight and obesity boys was 19.6%, 28.7%, 34.4% and 31.5%, respectively. The age of puberty onset was significantly earlier in obese boys (F=3.23, P<0.05). The results of Logistic regression analysis showed that with the increase of BMI, the possibility of puberty onset and risk of early pubertal timing increased. After adjusting for confounding factors, the odds of puberty onset in boys with wasting decreased by 64.0% (OR=0.36, 95%CI=0.22-0.60), the possibility of puberty onset and risk of early pubertal timing in boys with obesity increased by 78.3% (OR=1.78, 95%CI=1.14-2.79) and 192.9% (OR=2.93, 95%CI=1.46-5.86), respectively. These relationships were more pronounced in boys of households with lower economic level (P<0.05). Conclusion BMI was positively correlated with puberty onset in boys, the odds of puberty onset and risk of early pubertal timing were significantly increased in obese boys, especially in those with low household economic level.

Objective: To investigate the prevalence and related factors of dyslipidemia among children and adolescents aged 6-17 years in 7 provinces in China. Methods: Using the method of stratified cluster random sampling, 93 primary and secondary schools were selected from Guangdong, Hunan, Liaoning provinces, Shanghai, Chongqing, Tianjin municipalities and Ningxia Hui Autonomous Region in China, 2012. A total of 16 434 students aged 6-17 years old with completed physical and lipid profiles parameters were selected into this study from above 93 primary and secondary schools. Dyslipidemia was determined by the definition of Expert Advice on Prevention and Treatment of Dyslipidemia in Children and Adolescents in 2009. Logistic regression model was used to explore the factors related to dyslipidemia. Results: The prevalence of elevated total cholesterol, elevated triglyceride, elevated low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, and dyslipidemia was 5.4% (887 cases), 15.7% (2 578 cases), 3.0% (492 cases), 13.5% (2 221 cases) and 28.5% (4 679 cases) among children and adolescents aged 6-17 years, respectively. Sugary drinks intake ≥once per week (OR=1.14; 95%CI: 1.05-1.24), sedentary time >10 hours per day (OR=1.14, 95%CI: 1.01-1.28), overweight (OR=1.50, 95%CI: 1.33-1.70), and obesity (OR=2.62, 95%CI: 2.31-2.96) were significantly associated with the prevalence of dyslipidemia. Conclusion The prevalence of dyslipidemia was high among children and adolescents aged 6-17 in 7 provinces in China, 2012. Sugary drinks intake ≥once per week, sedentary time >10 hours per day, overweight and obesity might be the risk factors of dyslipidemia among children and adolescents.

Objective To understand and evaluate the characteristics of geographic distribution of high blood pressure prevalence in children and adolescents aged 7-18 years in China in 2014,and provide evidence for the prevention of hypertension in children and adolescents.Methods The data of 2014 Chinese National Surveys on Students Constitution and Health conducting 31 provinces (except Hong Kong,Macao and Taiwan) were collected.A total of 216 299 children and adolescents who had complete blood pressure records were selected as study subjects.The low,middle and high prevalence areas were identified according to their high blood pressure detection rates in the children and adolescents,＜4％,4％-7％ and ＞7％,to analyze the geographic distribution of high blood pressure prevalence in the children and adolescents.The environmental data in the capitals of 31 provinces in 2014 were collected to analyze the correlation between environmental factors and blood pressure Z score in the children and adolescents.Results The average detection rates of high blood pressure was 6.4％ in 31 provinces (1.5％-14.2％).The high prevalence areas were mainly distributed in the eastern China,especially the Circum-Bohai sea area,low prevalence areas were mainly distributed in the central and western areas of China and some provinces in the east.Correlation analysis results showed that the annual average temperature,annual average air humidity and local altitude were negatively correlated with blood pressure Z score,including diastolic and systolic blood pressure,in both boys and girls.The annual average sunshine time,PM2.5 and PM10 concentrations,content of SO2 were positively correlated with blood pressure Z score in both boys and girls.Conclusions There was a significant difference in high blood pressure of children and adolescents among 31 provinces.More attention should be paid to the children and adolescents living high prevalence area.And it is necessary to understand environmental factors which can affect the blood pressure of children and adolescents.

Objective: This study aimed to explore the association between malnutrition and the level of blood pressure (BP) as well as elevated BP (EBP) in Han students aged 7 to 18 years in China. Methods: 170 037 subjects with normal nutritional status and malnutrition were enrolled in this study from 2014 Chinese National Surveys on Students' Constitution and Health with a multi-stage stratified cluster random sampling framework covering 31 provinces, autonomous regions and municipalities after the exclusion of 44 317 overweight and obese students. According to the standard of "Screening Standard for Malnutrition of School-age Children and Adolescents" (WS/T456-2014), the nutritional status of children were classified into two categories, normal nutritional status and malnutrition containing stunting, mild wasting and moderate severe wasting. The level of BP and prevalence of EBP were compared between students with normal nutritional status and malnutrition. The multivariate logistic regression model was used to analyze the association between malnutrition and EBP. Results: The levels of systolic BP (SBP) and diastolic BP (DBP) in Chinese Han students aged 7-18 years who were non-overweight and non-obesity status were (103.4±12.3) and (64.7±9.5) mmHg (1 mmHg=0.133 kPa), respectively. The prevalence of EBP, systolic EBP and diastolic EBP in Chinese Han malnourished students (N=21 012) were 3.1% (n=649), 1.5% (n=324) and 2.1% (n=445), respectively, which was significantly lower than those (N=148 320) with normal nutritional status (4.5% (n=6 707), 2.6% (n=3 872) and 2.7% (n=3 959)), and the corresponding differences were statistically significant (P<0.05). The OR (95%CI) between malnutrition and EBP was 0.68 (0.62-0.73), which were 0.65 (0.58-0.72) and 0.68 (0.60-0.77) for boys and girls. The OR (95%CI) between EBP and stunting as well as mild wasting and moderate severe wasting were 0.69 (0.62-0.77), 0.63 (0.55-0.72) and 0.79 (0.60-1.05), respectively. Conclusion The level of BP and prevalence of EBP in Chinese Han students with malnutrition were lower than those with normal nutritional status. The negative correlation existed between malnutrition and EBP in Chinese Han students aged 7 to 18 years.