Vitamin A and vitamin D deficiencies or insufficiencies in children remain global public health problems. The deficiencies of both vitamin A and vitamin D exist in Chinese children, the deficiency of vitamin A is mainly marginal (about 30%) in children aged 0 - 12 years.Vitamin D deficiency and prevalence are common in healthy children aged 0 - 18 years, among which the severe deficiency rate is 2.46%, the deficiency rate is 21.57%, and the marginal deficiency rate is 28.71%.The deficiency rate gradually increases with the increase of age.Since the respective bioactive metabolites of vitamin A and vitamin D, retinoic acid and 1 and 25-dihydroxyvitamin D3 have hormone-like properties, and both metabolites are synthesized from their vitamin precursors by different tissues and cells in the body, there may be a synergistic effect between both on target cells remotely by binding to nuclear hormone receptors.A high proportion of concurrent vitamin A and vitamin D deficiencies (comorbidities) in malnourished children under 5 years of age in low- and middle-income countries and poor areas will affect the immune response in a highly specific way, in addition to causing growth and developmental disorders (e.g., growth retardation, motor retardation), it also increases susceptibility to infectious diseases (e.g., recurrent respiratory infections, diarrhea), allergic diseases (e.g., asthma, atopic dermatitis), and neurodevelopmental disorders (touretic disorder, autism spectrum disorder).Therefore, children in the period of growth and development may benefit from supplementing with vitamin A and vitamin D.

Chronic non-communicable diseases (NCDs) have become diseases that seriously threaten the health and quality of life of the Chinese population, and also become a major public health problem affecting the national economic and social development. With the intensification of China′s population aging, the economic burden caused by NCDs will further increase. More and more evidence has shown that NCDs could be prevented, and the prevention and control of NCDs have been considered as a core task of building a healthy China. Therefore, precise personalized nutrition and the prevention of NCDs from the age of zero, which is called the "Double Zero Strategy", would provide a well-consolidated basis for body tissue structure, and prevention of NCDs should also begin at age zero, and then extend to the first 1 000 days of life. The "Double Zero Strategy" preventive intervention can improve the nutritional status, balance diet and nutrition, and increase physical activity among children, adolescents, adults, and the elderly, all of which can reduce the risk of chronic disease, disability, and death. Therefore, launching the "Double Zero Strategy" for full life cycle prevention will help to achieve China′s health goals in the new era, and provide more comprehensive measures and plans for implementing the goal of a healthy China.

Objective:To study the predictive value of Barcelona clinic liver cancer (BCLC) staging system combined with albumin-indocyanine green (ALICE) score (ALICE-BCLC) in hepatectomy for hepatocellular carcinoma, and compare it with BCLC staging system combined with Child-Pugh score (CP-BCLC).Methods:The clinical data of 311 patients with hepatocellular carcinoma who underwent hepatectomy at Jinhua Hospital Affiliated to Zhejiang University from April 2012 to June 2021 were analyzed retrospectively. There were 271 males and 40 females, with a median age of 59 years old (range 26 to 92 years old). These patients were divided into two groups based on the ALICE-BCLC: the ALICE-BCLC grade 0 group ( n=63) and the ALICE-BCLC grade A group ( n=248); and another two groups based on the CP-BCLC: the CP-BCLC grade 0 group ( n=58) and the CP-BCLC grade A group ( n=253). The clinical data, including indocyanine green retention rate at 15 min, and albumin were collected and the scores were calculated. Follow-up was conducted by combining outpatient visits with telephone calls. The survival rate was calculated by the life method, and survival curves were drawn by the Kaplan-Meier method. The multivariate Cox regression model was used to determine the main factors affecting prognosis. Weighted Kappa was used to compare consistency of the two staging systems. Results:Multivariate analysis showed that a maximum tumor diameter >5 cm, total bilirubin >18 μmol/L, major hepatectomy, CP-BCLC grade A and ALICE-BCLC grade A to be independent risk factors affecting overall survival of patients with hepatocellular carcinoma after liver resection with curative intent (all P<0.05). The median survival of patients in the CP-BCLC grade 0 group and the CP-BCLC grade A group were 43.0 and 28.0 months, respectively. There was a significant difference between the two groups ( P=0.017). The median survival of patients in the ALICE-BCLC grade 0 group and the ALICE-BCLC grade A group were 41.4 and 28.1 months, respectively. There was a significant difference between the two groups ( P=0.035). The weighted Kappa coefficient of ALICE-BCLC and CP-BCLC was 0.949, showing a strong consistency ( P<0.001). Conclusion:ALICE-BCLC showed a good predictive value for prognosis of hepatocellular carcinoma after liver resection, and it had a similar overall prognostic discrimination ability as CP-BCLC.

Objective:To investiagte the ability of albumin-indocyanine green (ALICE) score, albumin-bilirubin (ALBI) score and Child-Pugh score in predicting postoperative liver failure (PHLF) in patients with hepatocellular carcinoma, and to determine the clinical value of ALICE score.Methods:The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery, Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed, including 350 males and 47 females, aged (58.9±11.2) years. Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF. The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic (ROC) curve, and compared with ALBI score and Child-Pugh score.Results:There were 74 patients with PHLF and 323 patients without PHLF. Multivariate logistic regression analysis showed that Child-Pugh score ( OR=1.630, 95% CI: 1.251-2.486, P=0.034), ALBI score ( OR=1.863, 95% CI: 1.028-3.119, P=0.049) and ALICE score ( OR=1.759, 95% CI: 1.216-3.078, P=0.038) were independent risk factors for PHLF in patients with hepatocellular carcinoma, and the risk of PHLF increased with the increase of grade. The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613 (95% CI: 0.564-0.662), the area under the ALBI score was 0.612 (95% CI: 0.563-0.661), and the area under the Child-Pugh score was 0.555 (95% CI: 0.505-0.605). The ALICE score was better than the Child-Pugh score, and the difference was statistically significant ( z=2.04, P=0.041). In small liver resection patients, ALICE score was better than Child-Pugh score ( z=2.61, P=0.009). There was no significant difference betwenn ALICE score and ALBI score ( z=0.06, P=0.954). Conclusion:ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma, especially in patients with small liver resection, its value is similar to ALBI score, but better than Child-Pugh score.

Objective: To investigate anemia rate and to analyze related factors in maternal women in Taicang of Jiangsu province. Methods: There were 13 278 pregnant women who had prenatal care and gave birth in 25 hospitals during 2014-2016 in Taicang of Jiangsu Province. We excluded 1 179 women who registered after 12 weeks of gestation, 144 women who did not test hemoglobin during gestation, and 25 women whose gestational weeks were incorrect. Finally, data from 11 930 pregnant women were analyzed. From the electronical medical record system of maternal and child health care, we obtained basic information of these pregnant women, their hemoglobin levels and related data during gestation and postpartum. Anemia rate was descripted, and factors associated with anemia were identified using multiple unconditional logistic regression. Results: Age of the 11 930 pregnant women was (27.0±4.5) years old, and the P₅₀ (P₂₅-P₇₅) of BMI at the first trimester was 21.4 (19.6-23.7) kg/m². The anemia rate during gestation was 37.2% (4 434/11 930). The anemia rate was 5.5% (276/5 035), 24.4% (1 802/7 377), and 47.8% (3 328/6 966) at the first, second and third trimesters, respectively. Anemia rate at 42 days postpartum was 19.9% (680/3 418). Multiple unconditional logistic regression indicated that anemia during gestation was related with maternal age <21 years old at prenatal registration (OR (95%CI): 1.28 (1.07-1.53)), body mass index(BMI) <18.5 kg/m² at the first trimester (OR (95%CI): 1.14 (1.00-1.29)), non-local residence (OR (95%CI): 1.35 (1.20-1.52)), education of middle school and lower (OR (95%CI): middle school: 1.24 (1.05-1.47), primary school: 1.36 (1.01-1.82)), occupation of housewife or farmer (OR (95%CI): housewife: 1.21 (1.06-1.38), farmer: 1.21 (1.03-1.44)). Anemia at 42 days postpartum was associated with multipara (OR(95%CI): 1.59 (1.12-2.27)), anemia at the first trimester (OR(95%CI): 3.26 (1.92-5.55)), no folic acid supplementation at the first trimester (OR(95%CI): 1.34 (1.00-1.80)), and hemorrhage≥500 ml during 24 h postpartum (OR(95%CI): 2.26 (1.02-4.97)). Conclusion Anemia rate was low for maternal women in Taicang of Jiangsu Province. The factors associated with gestational anemia included pregnant women's age, BMI, local or non-local residence, occupation, and education. The factors associated with postpartum anemia included multipara, anemia at the first trimester, no folic acid supplementation at the first trimester, and hemorrhage 24 h postpartum.

Objective: To investigate the prevalence of calf muscle cramps and possible influencing factors for pregnant women in China. Methods: Using a multi-stage stratified probability proportional to size cluster randomization sampling method during 2010-2012. A total of 3 582 pregnant women were investigated at 150 counties from 31 provinces in China mainland. Information on calf muscle cramps, demographic socio-economic status, pregnancy information, and the physical activities was collected through questionnaires. The semi-quantitative food frequency questionnaire (FFQ) was used to collect food intake of pregnant women. Dynamic cluster analysis was used to assess dietary pattern. Multiple logistic regression was used to investigate the possible influencing factors for calf muscle cramps. Results: The prevalence of calf muscle cramps was 32.9% (1 180/3 582) in Chinese pregnant women, which was 11.6% (87/748), 28.2% (420/1 492), and 50.2% (673/1 342), respectively, during the first, second and third trimester. There were significant differences between them (χ²=349.16, P<0.001). Dietary patterns of the pregnant women were classified into three groups, which called relatively balanced pattern, high vegetables and fruits pattern, and high dairy pattern. Among the three groups, the prevalence of calf muscle cramps was 32.0% (952/2 971), 37.2% (186/500), and 37.8% (42/111), with significant differences (χ²=6.39, P=0.041). The OR (95%CI) values of calf muscle cramps in the second and third trimester was 2.96 (2.28-3.83), and 8.02 (6.16-10.44), respectively, comparing with the first trimester. The OR (95%CI) values of calf muscle cramps in the women taking calcium before pregnant was 1.45 (1.19-1.76), comparing with the one who was not taken. The OR (95%CI) values of calf muscle cramps in the women who had been diagnosed by pregnancy-induced hypertension was 5.76 (2.06-16.12), comparing with the one who had not been diagnosed. The OR (95%CI) values of calf muscle cramps in the high vegetables and fruits pattern and high dairy pattern was 1.13 (0.91-1.41), and 1.18 (0.76-1.81), respectively, comparing with the relatively balanced pattern. Conclusion The prevalence of calf muscle cramps was relatively high in Chinese pregnant women, which was significantly different among three trimesters. The residential areas, occupation, and pregnancy-induced hypertension might be related to the prevalence of calf muscle cramps. However, there was no significant difference among different dietary patterns.

Objective: To investigate the prevalence of anemia and related risk factors for pregnant women in China. Method: Based on Chinese National Nutrition and Health Surveillance 2010-2012, a total of 3 501 pregnant women were investigated from 150 counties of 31 provinces, municipalities and autonomous regions in China, using a multi-stage stratified cluster randomization sampling method. General information of pregnant women, health status, and food intake during the gestation, was collected through a questionnaire investigation. 6 ml fasting venous blood was collected for the determination of hemoglobin concentration. Data were analyzed using multiple logistic regression to investigate the prevalence of anemia and the related influencing factors. Results: The 605 of 3 501 pregnant women had anemia. The prevalence of anemia was 17.2%; and mild anemia accounted for about 61.0% (369/605). Compared with the pregnant women living in the large cities, the OR (95%CI) of those living in the poor rural areas was 1.46 (1.08-1.98). Compared with the pregnant women living in the south area of China, the OR (95%CI) of those living in the north area of China was 1.39 (1.15-1.68); Compared with the pregnant women in the first trimester, the OR (95%CI) of those in the second trimester and the third trimester were 1.79 (1.33-2.43) and 2.11 (1.56-2.85), respectively. The OR (95%CI) of pregnant women who had used folic acid supplementation within the 6 months prior to gestation was 0.76 (0.63-0.93) compared with those who had not used. Conclusion From 2010 to 2012, the epidemic characteristics of anemia was mild for the pregnant women in China, and pregnant women residential areas, periods of pregnancy and whether to take folic acid were related to anemia.

Objective: To examine the status and related factors for gestational weight gain of Chinese pregnant women at different trimesters in 2010-2012. Methods: Participants were from Chinese National Nutrition and Health Surveillance in 2010-2012. Using a multi-stage stratified cluster random sampling method, we recruited 2 805 singleton pregnant women with gestational age 13 weeks or more from 31 provinces of China. A standard questionnaire was used to collect general information and pre-pregnancy weight; body weight and height of pregnant women were measured using a unified weighing scale and stadiometer, dietary intake during the previous year was collected using a food frequency questionnaire. A multiple logistic regression was used to analyze potential factors associated with appropriate gestational weight gain. Results: Among 2 805 pregnant women, 1 441 were in the second (13-27 weeks) and 1 364 in the third trimesters (≥28 weeks) . In the 2^nd trimester, 229 cases (15.9%), 440 cases (30.5%) and 772 cases (53.6%) were insufficient gestational weight gain, appropriate gestational weight gain and excessive gestational weight gain respectively. So were 256 cases (18.8%), 474 cases (34.8%), 634 cases (46.5%) in the 3^rd trimester respectively. In the multivariate unconditional logistic model, less fruit intake was associated with insufficient weight gain for women in the 2^nd trimester (OR (95%CI): 1.58 (1.06-2.34)). Pregnant women with Han ethnicity who live in the small/medium city had lower risk of insufficient weight gain in the 3^rd trimester (OR (95%CI): 0.58 (0.34-0.98)). Those pregnant women with physical activity <1 hour/day had a higher risk of excessive weight gain (OR (95%CI): 1.33 (1.02-1.73)). Conclusion The prevalence of appropriate gestational weight gain was low in China. Our study suggests that pregnant weight gain is associated with fruit intake, types of residential area and physical activity.

Objective: To analyze the status of gestational weight gain (GWG) among Chinese mothers who gave singleton and full-term births, and to look at optimal GWG ranges. Methods: In 2013, using the multi-stage stratified and population proportional cluster sampling method, we investigated 8 323 mother-child pairs at their 0-24 months postpartum from 55 counties (cities/districts) of 30 provinces (except Tibet) in mainland China. Questionnaire was used to collect data on body weight before pregnancy and delivery, diseases during gestation, hemorrhage or not at postpartum, child birth weight and length, and other information about pregnant outcomes. We measured mother's body weight and height, and child's body weight and length. Based on 'Chinese Adult Body Weight Standard’, we divided mothers into four groups according to their body weight before pregnancy: low weight (BMI<18.5 kg/m²), normal weight (BMI 18.5-23.9 kg/m²), overweight (BMI 24.0-27.9 kg/m²) and obesity (BMI≥28.0 kg/m²). The status of GWG was assessed by IOM optimal GWG guidelines. Chinese optimal GWG ranges were calculated according to the association of GWG with pregnant outcomes and anthropometry of mothers and children, and according to P25-P75 of GWG among mothers who had good pregnant outcomes and good anthropometry, and whose children had good anthropometry. The status of GWG was assessed by the new optimal ranges. Results: P50 (P25-P75) of GWG among the 8 323 mothers was 15.0 (10.0-19.0) kg. According to the proposed optimal GWG ranges of IOM, the proportions of inadequate, optimal and excessive GWG accounted for 27.2% (2 263 mothers), 36.2% (3 016 mothers) and 36.6% (3 044 mothers). The optimal GWG ranges for low weight, normal weight, overweight and obesity were 11.5-18.0, 10.0-15.0, 8.0-14.0 and 5.0-11.5 kg. Based on these optimal GWG ranges established in this study, the rates of inadequate, optimal and excessive GWG were 15.7% (1 303 mothers), 45.0% (3 744 mothers) and 39.3% (3 276 mothers), and these rates were significantly different from that defined by the IOM standards (χ2=345.36, P<0.001). Conclusion The median of GWG among Chinese mothers is 15.0 kg, which is at a relatively higher level. This study suggests the optimal GWG ranges for Chinese women who give singleton and full-term babies, which appears lower than IOM's.

Improvement of the nutrition and health status of pregnant women should be one of the top priority strategies of improving the physical fitness of next generation and reserve of talented person for national sustainable development. This paper reviews the nutrition and health status of pregnant women in China over the recent ten years and discusses the underlying factors and changing trends. The most popular nutrition-related problem is dietary imbalance, and many micronutrient intakes are lower than the recommended dietary intakes or adequate intakes, and some of nutrient intakes are still at a very low level for a long time such as vitamin D and calcium. The nutrition-related health problems are mainly anemia, vitamin D and vitamin A deficiencies; iodine intake is not in optimal state with a large proportion of inadequate and individual cases facing excessive intake risk. Overweight and obesity, pregnancy complications such as gastrocnemius muscle spasms, pregnancy hypertensive disorders and gestational diabetes were prevalent among pregnant women. We should address both malnutrition and nutrition imbalance in the same time in order to improve the nutrition and health status of pregnant women, by developing and implementing relevant laws and regulations, giving higher attention to pregnant women with advanced age, which in turns prevent a variety of micronutrient deficiencies, reduce adverse pregnant outcomes, and improve nutrition and health status of maternal and child.