Objective: To investigate the status of salt-restriction spoons use among residents in Zhejiang Province, so as to provide evidence for optimizing salt-reduction intervention strategies and preventing chronic disease. Methods: Residents aged 18-69 from five counties (cities/districts) in Zhejiang Province were selected using a multi-stage stratified random sampling method. Demographic characteristics, dietary habits, and salt-restriction spoons use were collected using questionnaires. The rate of salt-restriction spoons use and correct rate of salt-restriction spoons use were analyzed. Factors affecting salt-restriction spoons use among residents were analyzed by multivariable logistic regression model. Results: Totally 7 601 questionnaires were allocated, and 7 509 valid questionnaires were recovered, with an effective recovery rate of 98.79%. The respondents included 3 744 males (49.86%) and 3 765 females (50.14%). The mean age was (44.81±14.03) years. The rate of salt-restriction spoons use was 11.97%, the correct rate of salt-restriction spoon use was 52.73%. Multivariable logistic regression analysis showed that rural (OR=0.851, 95%CI: 0.731-0.991), education level of primary school and below (illiterate or semi-literate, OR=0.269, 95%CI: 0.172-0.420; primary school, OR=0.595, 95%CI: 0.436-0.811), and excessive dietary salt intake (OR=0.718, 95%CI: 0.559-0.922) were inhibiting factors for salt-restriction spoons use among residents; physical exercise (OR=1.581, 95%CI: 1.362-1.836) and received health education on a low-salt diet (OR=2.082, 95%CI: 1.790-2.421) were promoting factors for salt-restriction spoons use among residents. Conclusions The rate of salt-restriction spoons use among residents in Zhejiang Province was relatively low, primarily influenced by region, educational level, physical activity, dietary salt intake, and health education on a low-salt diet. It is recommended that propose a multi-component intervention strategy centered on skill enhancement and health education, delivered through progressive staged implementation, to promote sustained adoption of salt-restriction spoons among residents.

Objective: To investigate the prevalence levels and trends of overweight and obesity among adult residents in Zhejiang Province from 2015 to 2023, so as to provide a basis for developing regional weight management strategies. Methods: Permanent residents aged ≥18 years from Zhejiang Province who participated in the China Chronic Disease and Risk Factor Surveillance Project in 2015, 2018, and 2023 were selected as survey subjects. Data on sociodemographic information, height, weight and waist circumference were collected through questionnaire surveys and physical examinations. The prevalence of overweight, obesity, and central obesity were calculated and standardized using data from the Seventh National Population Census of Zhejiang Province in 2020. The Cochran-Armitage trend test was employed to analyze the trends in prevalence of overweight, obesity, and central obesity across different genders, ages and regions. Results: A total of 23 902 individuals were surveyed, comprising 10 985 males (45.96%) and 12 917 females (54.04%). Participants were aged ≥60 years, with 13 088 individuals accounting for 54.76%. There were 9 388 urban residents (39.28%) and 14 514 rural residents (60.72%). The standardized prevalence of overweight among residents increased from 30.05% in 2015 to 33.98% in 2023, the standardized prevalence of obesity increased from 7.67% to 15.22%, and the standardized prevalence of central obesity increased from 22.81% to 33.82%, all showed upward trends (all P<0.05). In 2015, 2018, and 2023, the standardized prevalence of overweight was higher in males than in females. In 2018 and 2023, the standardized prevalence of obesity and central obesity were higher in males than in females (all P<0.05). From 2015 to 2023, the standardized prevalence of overweight, obesity, and central obesity among both males and females showed upward trends (all P<0.05). In 2015, 2018 and 2023, the prevalence of central obesity showed an increasing trend with age (all P<0.05). From 2015 to 2023, upward trends were observed in the prevalence of overweight, obesity, and central obesity among residents aged 18-<45 years and aged ≥60 years, as well as in the prevalence of obesity and central obesity among residents aged 45-<60 years (all P<0.05). In 2015, 2018 and 2023, the standardized prevalence of overweight obesity were higher in urban areas than in rural areas, while the standardized prevalence of central obesity was lower in urban areas (all P<0.05). From 2015 to 2023, the standardized prevalence of overweight, obesity, and central obesity among both urban and rural areas showed upward trends (all P<0.05). Conclusion From 2015 to 2023, the prevalence of overweight, obesity, and central obesity among adult residents in Zhejiang Province showed increasing trends, with variations in prevalence levels and trends observed across genders, ages, and urban / rural areas.

Objective:To investigate the association between obesity and the risk for all-cause mortality in type 2 diabetes (T2DM) patients.Methods:The participants were from a rural community-based T2DM patient cohort in Zhejiang Province. The study used the data collected from baseline survey in 2016 and follow-up until December 31, 2021. A total of 10 310 participants were included, excluding those who were lost in follow-up or had incomplete data in follow-up. According to BMI and waist circumference, the study subjects were divided into 6 groups: low body weight, normal body weight, simple abdominal obesity, simple body obesity, complex overweight and complex obesity. Cox proportional hazards regression model was used to analyze hazard ratios ( HRs) of all-cause mortality and their 95% CIs in T2DM patients with different obesity status. Results:The cumulative follow-up period was 57 049.47 person-years with an average follow-up of (5.53±0.89) person-years. During this period, 971 subjects died. The death density was 1 702.03/100 000 person-years. After adjusting for confounders, low-weight patients had a 104% increased risk for all-cause death compared with normal-weight patients ( HR=2.04, 95% CI:1.42-2.92). The risk for all-cause death decreased by 34% ( HR=0.66, 95% CI: 0.53-0.82), 22% ( HR=0.78,95% CI: 0.66-0.92), 38% ( HR=0.62, 95% CI: 0.49-0.78) in the patients with simple body obesity, complex overweight and complex obesity, respectively, there was no significant difference for all-cause death in the patients with simple abdominal obesity alone. In subgroup analysis, the risk of all-cause mortality increased in low-weight T2DM patients of different sexes and ages, the mortality risk in women with complex obesity was 50% lower than that in the women with normal body weight, but there was no significant difference in men in the comparison between complex obesity group and normal body weight group. The risk for all-cause mortality was significantly lower in ≥65 years old patients with simple body obesity, complex overweight and complex obesity than in patients with normal body weight ( HR=0.61, 95% CI: 0.48-0.78; HR=0.76, 95% CI: 0.63-0.91; HR=0.56,95% CI: 0.42-0.73), there was no significant difference in the patients aged <65 years. There was no significant change in sensitivity analysis. Conclusions:There was an "obesity paradox" in the risk for all-cause mortality in T2DM patients. The risk of all-cause mortality in the low-weight patients was significantly higher than that in normal-weight patients, and the risk for death in the patients with simple body obesity or complex overweight and obesity were significantly lower.

Objective To investigate the effect of agomelatine on the clinical efficacy in elderly patients with acute cerebral infarction(ACI)and comorbid anxiety-depression disorders by regu-lating serum neurotransmitters and nerve cytokines.Methods A total of 160 elderly ACI patients with anxiety and depression symptoms admitted in Pingxiang Second People's Hospital from June 2020 to December 2023 were enrolled in this study.All of them received thrombolysis or interven-tional therapy,and then were randomly divided into control and observation groups,with 80 patients in each group.The control group received conventional psychological intervention,while the observation group was given additional oral administration of agomelatine.Cognitive function,neurological function,neurotransmitters and neuronal cytokines,anxiety and depression scores,sleep quality,quality of life,daily activity ability and adverse reactions were compared between the two groups.Results After intervention,Mini Mental State Examination(MMSE)scores,levels of neuropeptide Y(NPY),5-hydroxytryptamine(5-HT),norepinephrine(NE),dopamine and brain-derived neurotrophic factor(BDNF),36-item Brief Health Questionnaire(SF-36)score,and Bar-thel index scale score were significantly higher in both 2 groups when compared with above indicators before the intervention(P＜0.01).And the MMSE score,NPY,5-HT,NE,dopamine and BDNF levels,SF-36 score and Barthel index scale score were obviously higher in the observa-tion group than the control group(P＜0.01).Both groups obtained notably lower NIHSS score,S100 calcium binding protein B(S100B)and myelin basic protein(MBP)levels,Hamilton Anxiety Rating Scale(HAMA)score,and Hamilton Depression Rating Scale 17(H AMD-17)score and Pittsburgh Sleep Quality Index(PSQI)score after intervention(P＜0.01).And the NIHSS score,S100B and MBP levels,HAMA score,HAMD-17 score,and PSQI score were statistically lower in the observation group than the control group(P＜0.01).During the treatment process,no signifi-cant difference was observed in the incidence of total adverse reactions between the two groups(3.75％vs 6.25％,x2=0.526,P=0.468).Conclusion When agomelatine tablets are indicated for ACI patients with concomitant anxiety-depression disorders,they can effectively rehabilitate cog-nitive function,enhance neurological function,improve sleep quality and quality of life,optimize activities of daily living,eliminate negative emotions,and correct the expression of neurotransmit-ters and neurotrophic factors.

Objective: To investigate the degree and influencing factors of glycosylated hemoglobin ( HbA1c ) control among patients with type 2 diabetes ( T2DM ) living in rural communities of Zhejiang Province, so as to provide the reference for optimizing the management of diabetes patients in rural communities. Methods: Permanent adult patients with T2DM that were registered and received standardized management in all communities of Jiashan County and Suichang County, and 6 communities of Yongkang City, Zhejiang Province in 2016 were recruited, and their demographic characteristics were captured from the health record system and chronic disease management system. The height, body weight, waist circumstance and blood pressure were measured, and HbA1c and blood lipid parameters were detected. The degree of HbA1c control ( <7% ) was analyzed, and its influencing factors were identified using a multivariable logistic regression model. Results: A total of 10 339 patients with T2DM were enrolled, including 4 520 men ( 43.72% ) and 5 819 women ( 56.28% ), with a mean age of ( 63.54±9.78 ) years and the mean course of diabetes of ( 6.36±4.73 ) years. The rate of HbA1c control was 47.89%. Multivariable logistic regression analysis showed that males ( OR=1.123, 95%CI: 1.024-1.233 ), region ( Suichang, OR=2.413, 95%CI: 2.106-2.765; Yongkang, OR=2.460, 95%CI: 2.188-2.767 ), course of disease ( 5-9 years, OR=1.724, 95%CI: 1.504-1.977; 10 years and longer, OR=2.881, 95%CI: 2.477-3.351 ), use of hypoglycemic drugs ( OR=1.203, 95%CI: 1.089-1.329 ), development of chronic complications ( OR=1.190, 95%CI: 1.027-1.379 ), uncontrolled blood pressure ( OR=1.140, 95%CI: 1.030-1.261 ), uncontrolled blood lipid ( OR=1.258, 95%CI: 1.104-1.433 ), and smoking ( OR=1.318, 95%CI: 1.165-1.491 ) were statistically associated with HbA1c control among T2DM patients. Conclusion The rate of HbA1c control was 47.89% among T2DM patients in rural communities of Zhejiang Province. HbA1c control should be given a high priority among men living in low-economic-level regions with long course of disease, use of hypoglycemic drugs, chronic complications, smoking, uncontrolled blood pressure and lipid.

Objective: To examine the correlation between frailty and lifestyle factors among middle-aged and elderly populations, so as to provide insights into the management of frailty among middle-aged and elderly populations. Methods : Middle-aged and elderly residents at ages of 45 ot 69 years were recruited using the convenient sampling method from seven townships in Changxing County of Zhejiang Province from 2019 to 2020. The demographic characteristics and lifestyle factors were collected using questionnaires, and the frailty was measured using the Chinese version of Tilburg Frailty Indicator ( TFI ). Factors affecting frailty were identified among middle-aged and elderly populations using the multivariable logistic regression model. Results: A total of 7 170 residents were surveyed, including 2 780 males ( 38.77% ) and 4 390 females ( 61.23% ), which had a median age of 56 (interquartile range, 10) years. The median frailty score was 2 (interquartile range, 3 ) among the study subjects, and the median frailty score was 2 ( interquartile range, 2 ) among residents at ages of 45 to 59 years, and 2 (interquartile range, 3) among residents at ages of 60 to 69 years. The overall detection of frailty was 16.07%, and the detection of frailty was 13.52% among subjects at ages of 45 to 59 years and 21.01% among subjects at ages of 60 to 69 years. Multivariable logistic regression analysis identified physical activity ( OR=0.826, 95%CI: 0.719-0.949 ) and sleep quality ( OR: 3.376-11.493, 95%CI: 2.907-15.808 ) as factors affecting frailty among middle-aged and elderly residents. Following age stratification, physical activity ( OR=0.817, 95%CI: 0.681-0.981 ) and sleep quality ( OR: 3.076-11.566, 95%CI: 2.518-18.216 ) as factors affecting frailty among subjects at ages of 45 to 59 years, while sleep quality ( OR: 3.777-11.827, 95%CI: 3.002-18.547 ) significantly correlated with frailty among residents at ages of 60 to 69 years. Conclusion Physical activity and sleep quality are associated with the risk of frailty among middle-aged and elderly populations.

Objective:To investigate the correlation between subclinical hypothyroidism (SCH) and clinical outcomes of patients with acute ischemic stroke.Methods:From July 2014 to October 2017, patients with acute ischemic stroke admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University were enrolled retrospectively. Their demographic and baseline clinical and laboratory data were collected. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after the onset of symptoms. Multivariate logistic regression analysis was used to determine the independent correlation between SCH and clinical outcome of patients with acute ischemic stroke. Results:A total of 200 patients with acute ischemic stroke were enrolled, including 107 males (53.5%) and 93 females (46.5%). Their age was 69.67±11.38 years. There were 45 patients (22.5%) with SCH, 160 (80.0%) with good outcomes, and 40 (20.0%) had poor outcomes. Univariate analysis showed that there were significant differences in the baseline National Institutes of Health Stroke Scale (NIHSS) score, stroke etiology classification and the proportion of patients with SCH between the poor outcome group and the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that high NIHSS score (odds ratio 2.884, 95% confidence interval 2.005-4.147; P=0.001) and SCH (odds ratio 19.527, 95% confidence interval 2.334-163.386; P=0.006) were the independent risk factors for poor outcomes. Conclusion:High NIHSS score and SCH were associated with the poor outcomes at 3 months after the onset of acute ischemic stroke.

Objective : To explore the relationship between alcohol consumption and hypertension in adults of Zhejiang Province, so as to provide scientific evidence for the prevention and control of hypertension. Methods: Data were collected from 10 national surveillance sites in Zhejiang Province in the 2018 China Chronic Disease and Risk Factors Surveillance. The multivariate logistic regression model was used to explore the relationship between alcohol consumption and hypertension in adults of Zhejiang Province. Results : Among 5 908 people included, 2 641 were males, accounting for 50.38%; and 3 267 were females, accounting for 49.62%. There were 2 721 cases of hypertension ( 28.54% ). The number of the cases with no, light and excessive alcohol consumption was 3 945, 1 117 and 846, accounting for 66.28%, 23.65% and 10.07%, respectively, after complex sampling weighting. The results of the multivariate logistic regression model showed that compared with those with no alcohol consumption, the adults with excessive alcohol consumption had higher risk of hypertension ( OR=2.126, 95%CI: 1.649-2.741 ); men with light ( OR=1.875, 95%CI: 1.075-3.270 ) and excessive alcohol consumption ( OR=2.752, 95%CI: 2.021-3.748 ) had higher risk of hypertension; the 18-<45-year-old adults with light ( OR=2.441, 95%CI: 1.171-5.087 ) and excessive alcohol consumption ( OR=3.368, 95%CI: 1.609-7.049 ), and the ≥60-year-old adults with excessive alcohol consumption ( OR=1.632, 95%CI: 1.174-2.269 ) had higher risk of hypertension. Conclusions Light and excessive alcohol consumption are associated with hypertension in Zhejiang adults. The association is stronger between excessive alcohol consumption and hypertension than between light alcohol consumption and hypertension.

Objectives:To investigate the association between body mass index (BMI) changes and other risk factors for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM).Methods:Based on the T2DM cohort in rural communities of Zhejiang province, baseline and follow up information of height, weight, blood pressure, glycated hemoglobin (HbA1c), TC, TG, LDL-C and HDL-C of the T2DM patients were collected. After excluding those who died during the follow-up period, lost follow-up or had incomplete information, a total of 8 953 T2DM patients were included in the final analysis. Multiple linear regression and Cox proportional hazards regression models were used for analysis.Results:At baseline survey, 40.97% of the T2DM patients were overweight and obese. Compared with those with normal BMI, the SBP, DBP and TG level were significantly higher, while HDL-C level was significantly lower in the overweight and obese T2DM patients ( P<0.01). During the follow-up period, the blood glucose control rate in the patients increased by 15%, and the levels of HbA1c decreased in the patients with different BMI changes at different degrees. Compared with the patients who kept normal BMI, the HbA1c level decrease had a smaller range, while the SBP and DBP increase had a larger range in the patients with persistent overweight and obesity, and their substandard rates of HbA1c, SBP, DBP, TG, HDL-C levels were 1.142 (1.057-1.233) times, 1.123 (1.055-1.196) times, 1.220 (1.128-1.320) times, 1.400 (1.282-1.528) times and 1.164 (1.069-1.267) times higher. The changes of blood pressure, blood lipids and other related indicators in the patients whose BMI became abnormal were similar to those of the patients with persistent overweight and obesity; Compared with the patients whose BMI were kept normal, the differences in changes and substandard rate of blood glucose level, blood pressure level in the patients whose BMI became normal were not significant ( P>0.05). The change value of BMI was positively correlated with the change value of SBP, DBP, TG and LDL-C, while negatively correlated with the change value of HDL-C ( P<0.05). Conclusions:Abnormal changes in BMI are associated with the adverse changes of blood glucose level, blood pressure, and blood lipids level and other cardiovascular disease risk factors. Keeping normal BMI would benefit the positive outcome of cardiovascular adverse factors.

Objective: To learn the prevalence of dyslipidemia and its influencing factors among patients with type 2 diabetes mellitus (T2DM) in rural areas of Zhejiang Province, and to provide evidence for dyslipidemia control. Methods: A sample of 10 343 patients with T2DM managed by communities from three counties (Jiashan,Suichang and Yongkang) were recruited. Through the residents’ health record system and specific investigation, demographic features,physical examination results of blood pressure,height, weight, waist circumstance (WC), glycated hemoglobin (HbA1c),total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were collected to analyze the spectrum of dyslipidemia. A logistic regression model was established to explore the associated factors of dyslipidemia. Results : The prevalence rate of dyslipidemia among the patients with T2DM in rural communities was 66.91%. The prevalence rates of higher level of TC, TG, LDL-C were 41.76%, 41.28%, 15.89%, respectively, while the prevalence rateof lower level of HDL-C was 16.92%. The prevalence rates of purely high TC,high TC with TG and purely high TG were 11.84%,11.75% and 11.47%,respectively. Higher level of TG with lower level of HDL-C was common in males (11.32%) and higher level of TC with TG was common in females (14.60%). The results from multivariate logistic regression analysis indicated that females(OR=1.499,95%CI:1.352-1.663),age(OR=0.992,95%CI:0.988-0.996),poor control of HbA1c(OR=1.241,95%CI:1.141-1.351), abdominal obesity(OR=1.169,95%CI:1.064-1.285),overweight(OR=1.384,95%CI:1.257-1.524)and obesity(OR=1.582,95%CI:1.352-1.852)were associated with dyslipidemia. Conclusions The prevalence of dyslipidemia is relatively higher among the patients with T2DM in rural communities of Zhejiang Province. Higher level of TC and TG contributed to most dyslipidemia. The patients with T2DM who are females,have poor control of plasma glucose and suffer from obesity should be under surveillance.