1.Mechanism of Yizhi Qingxin Prescription in Regulating PKA/CaN Pathway to Improve Cognitive Function in Alzheimer's Disease Model Mice
Xiaochen GUO ; Jiangang LIU ; Dandan SHI ; Ziqi NING ; Yaoyao ZHANG ; Fang LIU ; Meixia LIU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(3):97-108
ObjectiveTo explore the mechanism by which Yizhi Qingxin prescription improves mitochondrial dysfunction in Alzheimer's disease (AD) through regulating mitochondrial Ca2+ homeostasis and kinetic balance based on the protein kinase A (PKA)/calcineurin (CaN) signaling pathway. MethodsSixty three-month-old amyloid precursor protein (APP)/presenilin 1 (PS1) double transgenic mice were randomly divided into a model group, a donepezil group(0.65 mg·kg-1), a low-dose Yizhi Qingxin prescription group (YQF-L,2.6 g·kg-1), a medium-dose Yizhi Qingxin prescription group (YQF-M,5.2 g·kg-1), and a high-dose Yizhi Qingxin prescription group (YQF-H,10.4 g·kg-1), with 12 mice in each group. Twelve C57BL/6J mice with the same genetic background served as a normal group. Each treatment group received gavage administration daily, with the model and normal groups receiving equal volume of physiological saline. Intervention continued for 12 consecutive weeks. The learning and memory abilities of the mice were assessed using the novel object recognition (NOR) and Morris water maze (MWM) tests. Hematoxylin-eosin (HE)/Nissl staining was used to observe histopathological changes in the hippocampus. Transmission electron microscopy (TEM) was used to observe mitochondrial ultrastructure. Fluo-4 acetoxymethyl ester (Fluo-4 AM) Ca2+ probe was used to measure intracellular Ca2+ concentration in brain tissue. Western blot was used to determine the protein expression of PKA, CaN, sodium/calcium/lithium exchanger (NCLX), mitochondrial calcium uniporter (MCU), calmodulin (CaM), dynamin-related protein 1 (Drp1), and phosphorylated dynamin-related protein 1 (serine 637 site) [p-Drp1(S637)] in the hippocampus. Real-time quantitative polymerase chain reaction (Real-time PCR) was used to measure the expression of PKA, CaN, CaM, NCLX, MCU, and Drp1 mRNAs. ResultsCompared with those in the normal group, the recognition index (RI) of the model group decreased (P0.01), and the number of crossings through the original platform area, the duration of stay in the target quadrant, and the distance were reduced (P0.01). The protein expression of PKA, NCLX, and p-DRP1 (ser637) significantly decreased (P0.05), and the mRNA expression of PKA and NCLX significantly decreased (P0.05). The escape latency (EL) was prolonged (P0.05), and the intracellular Ca2+ level significantly increased (P0.01). The protein expression of CaN, CaM, MCU, and Drp1, as well as the mRNA expression of CaN, MCU, and Drp1, significantly increased (P0.05). After intervention with Donepezil and Yizhi Qingxin prescription, compared with that in the model group, the RI of the treatment group significantly increased (P0.05), and the number of crossings through the platform and the duration of stay in the target quadrant significantly increased (P0.05). The protein expression of PKA, NCLX, and p-Drp1 (ser637) and the mRNA expression of PKA and NCLX significantly increased (P0.05). On the 4th and 5th days, the EL was shortened (P0.05), and the intracellular Ca2+ level decreased (P0.05). The protein expression of CaN, CaM, MCU, and Drp1 and the mRNA expression of CaN, MCU, and Drp1 significantly decreased (P0.05). ConclusionYizhi Qingxin prescription regulates the PKA/CaN pathway, upregulates the expression of PKA, NCLX, and p-Drp1 (ser637) proteins, reduces the expression of CaN, CaM, MCU, and Drp1 proteins, and regulates Ca2+ homeostasis and mitochondrial dynamic balance, thereby enhancing the spatial learning and memory abilities of AD mice.
2.Mechanism of Yizhi Qingxin Prescription in Regulating PKA/CaN Pathway to Improve Cognitive Function in Alzheimer's Disease Model Mice
Xiaochen GUO ; Jiangang LIU ; Dandan SHI ; Ziqi NING ; Yaoyao ZHANG ; Fang LIU ; Meixia LIU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(3):97-108
ObjectiveTo explore the mechanism by which Yizhi Qingxin prescription improves mitochondrial dysfunction in Alzheimer's disease (AD) through regulating mitochondrial Ca2+ homeostasis and kinetic balance based on the protein kinase A (PKA)/calcineurin (CaN) signaling pathway. MethodsSixty three-month-old amyloid precursor protein (APP)/presenilin 1 (PS1) double transgenic mice were randomly divided into a model group, a donepezil group(0.65 mg·kg-1), a low-dose Yizhi Qingxin prescription group (YQF-L,2.6 g·kg-1), a medium-dose Yizhi Qingxin prescription group (YQF-M,5.2 g·kg-1), and a high-dose Yizhi Qingxin prescription group (YQF-H,10.4 g·kg-1), with 12 mice in each group. Twelve C57BL/6J mice with the same genetic background served as a normal group. Each treatment group received gavage administration daily, with the model and normal groups receiving equal volume of physiological saline. Intervention continued for 12 consecutive weeks. The learning and memory abilities of the mice were assessed using the novel object recognition (NOR) and Morris water maze (MWM) tests. Hematoxylin-eosin (HE)/Nissl staining was used to observe histopathological changes in the hippocampus. Transmission electron microscopy (TEM) was used to observe mitochondrial ultrastructure. Fluo-4 acetoxymethyl ester (Fluo-4 AM) Ca2+ probe was used to measure intracellular Ca2+ concentration in brain tissue. Western blot was used to determine the protein expression of PKA, CaN, sodium/calcium/lithium exchanger (NCLX), mitochondrial calcium uniporter (MCU), calmodulin (CaM), dynamin-related protein 1 (Drp1), and phosphorylated dynamin-related protein 1 (serine 637 site) [p-Drp1(S637)] in the hippocampus. Real-time quantitative polymerase chain reaction (Real-time PCR) was used to measure the expression of PKA, CaN, CaM, NCLX, MCU, and Drp1 mRNAs. ResultsCompared with those in the normal group, the recognition index (RI) of the model group decreased (P0.01), and the number of crossings through the original platform area, the duration of stay in the target quadrant, and the distance were reduced (P0.01). The protein expression of PKA, NCLX, and p-DRP1 (ser637) significantly decreased (P0.05), and the mRNA expression of PKA and NCLX significantly decreased (P0.05). The escape latency (EL) was prolonged (P0.05), and the intracellular Ca2+ level significantly increased (P0.01). The protein expression of CaN, CaM, MCU, and Drp1, as well as the mRNA expression of CaN, MCU, and Drp1, significantly increased (P0.05). After intervention with Donepezil and Yizhi Qingxin prescription, compared with that in the model group, the RI of the treatment group significantly increased (P0.05), and the number of crossings through the platform and the duration of stay in the target quadrant significantly increased (P0.05). The protein expression of PKA, NCLX, and p-Drp1 (ser637) and the mRNA expression of PKA and NCLX significantly increased (P0.05). On the 4th and 5th days, the EL was shortened (P0.05), and the intracellular Ca2+ level decreased (P0.05). The protein expression of CaN, CaM, MCU, and Drp1 and the mRNA expression of CaN, MCU, and Drp1 significantly decreased (P0.05). ConclusionYizhi Qingxin prescription regulates the PKA/CaN pathway, upregulates the expression of PKA, NCLX, and p-Drp1 (ser637) proteins, reduces the expression of CaN, CaM, MCU, and Drp1 proteins, and regulates Ca2+ homeostasis and mitochondrial dynamic balance, thereby enhancing the spatial learning and memory abilities of AD mice.
3.Neuroprotective Effect of Baicalein in Parkinson's Disease Model Rats and Its Impact on PERK/ATF4 Endoplasmic Reticulum Stress Pathway
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(8):74-81
ObjectiveTo investigate the neuroprotective mechanism of baicalein (BAI) on Parkinson's disease (PD) model rats by regulating endoplasmic reticulum stress pathway. MethodsSeventy-two Sprague-Dawley (SD) rats were randomly divided into normal group, model group, BAI low-dose group (80 mg·kg-1), medium-dose group (120 mg·kg-1), high-dose group (160 mg·kg-1), and levodopa-benserazide group (51 mg·kg-1), with 12 rats per group. Except for the normal group, PD rat models were established by subcutaneous injection of rotenone solution (2 mg·kg-1) into the neck back of rats in the rest of groups for consecutive 28 days. Concurrently, rats in all groups received corresponding drugs via gavage for 28 days. After treatment, behavioral changes were assessed by using the open field and pole climbing tests. Neuronal pathology and apoptosis in the substantia nigra were observed via hematoxylin-eosin (HE) staining and TdT-mediated dUTP nick-end labeling (TUNEL) assay. α-Synuclein and tyrosine hydroxylase (TH) expressions were detected by immunohistochemistry (IHC). Inflammatory factors such as interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA). RNA-like endoplasmic reticulum kinase (PERK), activating transcription factor 4 (ATF4), C/EBP-homologous protein (CHOP), and Bcl-2-associated X protein (Bax) expressions were analyzed by Western blot. ResultsCompared with the normal group, the model group exhibited significantly reduced locomotion distance (P<0.01) and elevated pole-climbing scores (P<0.01), with increased neuronal apoptosis rate (P<0.01), significantly enhanced α-Synuclein expression (P<0.01), decreased TH expression (P<0.01), upregulated release of inflammatory factors (P<0.05,P<0.01), and increased protein expressions of PERK/ATF4 pathway proteins and pro-apoptotic Bax (P<0.05,P<0.01). Compared with the model group, medium/high-dose BAI groups and levodopa-benserazide group showed obviously improved motor function (P<0.05,P<0.01), reduced pole-climbing scores (P<0.05), decreased neuronal apoptosis (P<0.01), downregulated α-Synuclein expression (P<0.01), upregulated TH expression (P<0.05,P<0.01), suppressed release of inflammatory factors (P<0.05,P<0.01), and decreased protein expressions of PERK/ATF4 pathway proteins and pro-apoptotic Bax (P<0.05,P<0.01). ConclusionBAI reduces the release of neuroinflammatory factors and neuronal apoptosis to improve the neurological function of PD model rats, and its mechanism may be related to alleviating endoplasmic reticulum stress and apoptosis by regulating the PERK/ATF4 pathway.
4.Neuroprotective Effect of Baicalein in Parkinson's Disease Model Rats and Its Impact on PERK/ATF4 Endoplasmic Reticulum Stress Pathway
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(8):74-81
ObjectiveTo investigate the neuroprotective mechanism of baicalein (BAI) on Parkinson's disease (PD) model rats by regulating endoplasmic reticulum stress pathway. MethodsSeventy-two Sprague-Dawley (SD) rats were randomly divided into normal group, model group, BAI low-dose group (80 mg·kg-1), medium-dose group (120 mg·kg-1), high-dose group (160 mg·kg-1), and levodopa-benserazide group (51 mg·kg-1), with 12 rats per group. Except for the normal group, PD rat models were established by subcutaneous injection of rotenone solution (2 mg·kg-1) into the neck back of rats in the rest of groups for consecutive 28 days. Concurrently, rats in all groups received corresponding drugs via gavage for 28 days. After treatment, behavioral changes were assessed by using the open field and pole climbing tests. Neuronal pathology and apoptosis in the substantia nigra were observed via hematoxylin-eosin (HE) staining and TdT-mediated dUTP nick-end labeling (TUNEL) assay. α-Synuclein and tyrosine hydroxylase (TH) expressions were detected by immunohistochemistry (IHC). Inflammatory factors such as interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA). RNA-like endoplasmic reticulum kinase (PERK), activating transcription factor 4 (ATF4), C/EBP-homologous protein (CHOP), and Bcl-2-associated X protein (Bax) expressions were analyzed by Western blot. ResultsCompared with the normal group, the model group exhibited significantly reduced locomotion distance (P<0.01) and elevated pole-climbing scores (P<0.01), with increased neuronal apoptosis rate (P<0.01), significantly enhanced α-Synuclein expression (P<0.01), decreased TH expression (P<0.01), upregulated release of inflammatory factors (P<0.05,P<0.01), and increased protein expressions of PERK/ATF4 pathway proteins and pro-apoptotic Bax (P<0.05,P<0.01). Compared with the model group, medium/high-dose BAI groups and levodopa-benserazide group showed obviously improved motor function (P<0.05,P<0.01), reduced pole-climbing scores (P<0.05), decreased neuronal apoptosis (P<0.01), downregulated α-Synuclein expression (P<0.01), upregulated TH expression (P<0.05,P<0.01), suppressed release of inflammatory factors (P<0.05,P<0.01), and decreased protein expressions of PERK/ATF4 pathway proteins and pro-apoptotic Bax (P<0.05,P<0.01). ConclusionBAI reduces the release of neuroinflammatory factors and neuronal apoptosis to improve the neurological function of PD model rats, and its mechanism may be related to alleviating endoplasmic reticulum stress and apoptosis by regulating the PERK/ATF4 pathway.
5.Research progress on the relationship between serum vitamin D levels and myopia among children and adolescents
Chinese Journal of School Health 2026;47(3):443-447
Abstract
Myopia is a major global public health concern, characterized by high prevalence among children and adolescents, frequent ocular complications, and multifactorial etiology. One potential contributing factor is serum vitamin D level. The paper summarizes epidemiological studies examining the relationship between serum vitamin D levels and myopia among children and adolescents. It further discusses possible biological mechanisms and future research prospects in order to elucidate the relationship between vitamin D levels and myopia in children and adolescents, and to provide a theoretical basis for effective prevention/control interventions.
6.Epidemiological characteristics and antimicrobial resistance analyses of foodborne Vibrio parahaemolyticus in Wenzhou City of Zhejiang Province from 2016 to 2024
Maomao WU ; Yuqin HU ; Ziqi XIA ; Leyi ZHANG ; Minhe CHEN
Shanghai Journal of Preventive Medicine 2026;38(6):453-457
ObjectiveTo analyze the epidemiological status, serotypes, and drug resistance characteristics of Vibrio parahaemolyticus in foodborne disease surveillance in Wenzhou from 2016 to 2024, and to provide scientific evidence and data support for the prevention and control of Vibrio parahaemolyticus infections. MethodsA total of 45 980 stool or anal swab samples were collected from patients with vomiting and diarrhea as the main symptoms and a history of consuming suspicious food at medical institutions at all levels in Wenzhou from 2016 to 2024. Isolation, identification, and drug susceptibility testing were performed. Case information was collected through the National Foodborne Disease Surveillance Reporting System. The Cochran-Mantel-Haenszel (CMH) chi-square test was used to analyze the detection rates among groups. ResultsAmong the 45 980 suspected samples, 2 821 were positive for Vibrio parahaemolyticus, with an overall detection rate of 6.14%. A comparison of detection rates across different population groups revealed that the highest rates were found among adults aged 20‒39 (8.57%,1 603/18 697) and among farmers and workers (7.93%, 994/12 537). A comparison of detection rates across different seasons revealed that the detection rates were higher from June to October (5.12%, 9.04%, 15.04%, 14.68%, and 7.80%, respectively), peaking in August. Analyses of the sampling results for suspect foodstuffs revealed that aquatic products and their derivatives accounted for the highest proportion (42.86%). Regarding the setting of food consumption, the household accounted for 44.53% (1 257/2 821). From 2016 to 2020, the predominant serotype was O3:K6 (28.82%, 813/2 821), followed by O10:K4 (28.25%, 797/2 821) and O4:KUT (23.61%, 666/2 821). In terms of drug resistance, the resistance rate to cefazolin was the highest at 84.15% (393/467), and the multi-drug resistance rate was 6.21% (29/467). ConclusionFrom 2016 to 2024, patients with suspected foodborne illnesses in Wenzhou City experienced a peak in Vibrio parahaemolyticus infections during the summer and autumn months (June to October). Young adults aged 20‒39, as well as farmers and manual workers, were the key target groups for the prevention and control of Vibrio parahaemolyticus infections. The predominant serotype of Vibrio parahaemolyticus shifted from O3:K6 to O10:K4. Vibrio parahaemolyticus exhibited a high level of resistance to cefazolin. It is essential to strengthen surveillance of the epidemiological trends of the predominant serotype, monitor changes in the antibiotic resistance of Vibrio parahaemolyticus, enhance health education for key populations, and intensify regulatory inspections of high-risk foods such as aquatic products and their derivatives.
7.Chaihu Jia Longgu Muli Tang Inhibits Microglial Activation to Protect Neuro-2A Neurons
Xinqi YANG ; Ruixuan GAO ; Ziqi ZHANG ; Yongsen JIA ; Jingfeng OUYANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(22):31-39
ObjectiveTo examine the effects of Chaihu Jia Longgu Muli Tang (CLMT)-containing serum on Neuro-2A cell damage when exposed to conditioned medium from lipopolysaccharide (LPS)-stimulated microglia (BV-2) and explore the underlying mechanism. MethodsBV-2 cells were activated by LPS at a concentration of 1 mg·L-1 to generate conditioned medium. Concurrently, a blank control group, a model group and groups treated with varying concentrations of CLMT (5%, 10%, and 15%), dexamethasone (2.5 μmol·L-1), stimulator of interferon genes (STING) agonist (MSA-2, 10 μmol·L-1), and STING inhibitor (STING-IN-4, 4 μmol·L-1) were established. Neuro-2A cells were subsequently cultured in the conditioned medium from each treatment group. The viability of BV-2 cells following interventions was assessed by the cell counting kit-8 (CCK-8) assay. The levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) in the supernatant of Neuro-2A cells from each group were measured through enzyme linked immunosorbent assay (ELISA). Additionally, the expression of tyrosine hydroxylase (TH) in Neuro-2A cells was evaluated through immunohistochemistry (IHC), while the expression of phosphorylated alpha-synuclein (p-α-Syn) was assessed by immunofluorescence (IF) assay. The expression levels of STING, interferon regulatory factor 3 (IRF3), phosphorylated interferon regulatory factor 3 (p-IRF3), nuclear transcription factor-kappa B p65 (NF-κB p65), and phosphorylated nuclear transcription factor-kappa B p65 (p-NF-κB p65) in Neuro-2A cells were determined by Western blot. ResultsIn comparison to the control group, both the model group and the MSA-2 group exhibited reduced viability of Neuro-2A cells (P<0.01), elevated concentrations of TNF-α, IL-1β, and IL-6 in the cell supernatant (P<0.01), reduced expression of TH (P<0.01), increased expression of p-α-Syn (P<0.01), and upregulated relative protein levels of STING, p-IRF3, and p-NF-κB p65 (P<0.01). Compared with the model group, medium- and high-dose CLMT enhanced the viability of Neuro-2A cells (P<0.01), lowered the levels of TNF-α, IL-1β, and IL-6 (P<0.01), promoted TH expression, and suppressed p-α-Syn expression (P<0.01). In the dexamethasone group, the levels of IL-6, TNF-α, and IL-1β were reduced (P<0.05, P<0.01). In the STING-IN-4 group, the levels of TNF-α and IL-1β were decreased (P<0.01). The expression of TH was increased in both the dexamethasone group and the STING-IN-4 group (P<0.01), while the expression of p-α-Syn was reduced (P<0.01). The relative protein levels of p-IRF3, STING, and p-NF-κB p65 were reduced in medium- and high-dose CLMT groups (P<0.05, P<0.01). Similarly, the dexamethasone group exhibited decreases in the expression levels of STING, p-IRF3, and p-NF-κB p65 (P<0.01). In the STING-IN-4 group, the expression levels of p-NF-κB p65, STING, and p-IRF3 were also diminished (P<0.05, P<0.01). However, no statistically significant differences were observed in the expression of IRF3 or NF-κB p65 across the groups. ConclusionCLMT has the potential to suppress the activation of BV-2 microglial cells, consequently mitigating the inflammatory response induced by LPS and further preventing inflammation-mediated damage to Neuro-2A cells. The underlying mechanism is likely associated with the modulation of the STING/NF-κB signaling pathway, which results in reduced inflammation and confers neuroprotective effects.
8.Longitudinal cross lagged analysis of body mass index and weight stigma with depressive symptom in adolescents
DONG Ziqi, SONG Xinli, YUAN Wen, LI Jing, YANG Tian, ZHANG Xiuhong, SONG Yi, DONG Yanhui
Chinese Journal of School Health 2025;46(9):1242-1245
Objective:
To explore the bidirectional associations among body mass index Z scores (BMI Z scores) and weight stigma with depressive symptoms in adolescents, thereby providing evidence for targeted intervention strategies.
Methods:
A stratified cluster random sampling method was employed to select 18 301 adolescents aged 12-18 years from all 12 prefectures (103 counties) in the Inner Mongolia Autonomous Region, and two waves of longitudinal surveys were conducted in September 2023 (T1) and September 2024 (T2) among the adolescents. Weight stigma was assessed by using a self developed questionnaire, depressive symptom was measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and BMI Z scores were calculated according to the World Health Organization standards. Pearson correlation analysis was used to examine associations among variables, and cross lagged panel models were constructed to investigate the dynamic bidirectional relationships among the three variables.
Results:
Adolescents BMI Z scores and weight stigma with depressive symptoms all exhibited autoregressive stability across the two time points (autoregressive paths, all P <0.01). Cross lagged model comparisons indicated that the bidirectional path model achieved the best fit ( χ 2=12.65, RMSEA =0.017, CFI =1.000; △ χ 2=193.39, P <0.01), supporting dynamic bidirectional associations among the three variables. After adjusting for gender, age, subjective social status and only child status, T1 BMI Z scores among adolescents positively predicted T2 weight stigma ( β =0.061), and T1 weight stigma positively predicted T2 depressive symptoms ( β =0.608); in the reverse direction, T1 depressive symptoms predicted T2 weight stigma ( β =0.003), and T1 weight stigma predicted T2 BMI Z scores ( β =0.081) (all P <0.01).
Conclusions
There is a bidirectional cross lagged relationship among adolescents BMI Z scores and weight stigma with depressive symptoms, suggesting that weight stigma may serve as a key psychological variable linking obesity and depressive symptoms. Greater attention should be paid to the potential threat of weight stigma to adolescents mental health, with intervention strategies expanded from a solely physiological focus to encompass psychosocial dimensions.
9.Visualization analysis of research hotspots and trends in weight management for obese children from 2014 to 2024
ZHANG Ziqi, DONG Dengbo, ZOU Shengqiang
Chinese Journal of School Health 2025;46(9):1337-1341
Objective:
To analyze the research hotspots and advancements in weight management for obese children both domestically and internationally, providing a theoretical foundation for future studies of related fields.
Methods:
Relevant literature for weight management of obese children were retrieved from CNKI, Wanfang, Weipu, Web of Science (WOS) databases for the period from January 1, 2014, to December 31, 2024. Excel, CiteSpace, and VOSviewer were used to analyze annual publication volume, authors, institutions, keywords, and other bibliometric characteristics.
Results:
A total of 158 Chinese literature and 484 English literature were included. Domestic publications remained stable, while international publications fluctuated but stabilized during 2018-2022. The publication volume and institutional collaboration map indicated that foreign scholars collaborations were concentrated, whereas domestic collaborations were scattered. The foreign scholar with the highest number of publications was Ball (29 articles). And the country with the most publications was the United States (256 articles). Journal dual map overlay indicated future would focus on medicine, internal medicine and clinical medicine. Both domestic and foreign studies focused on participants, weight management methods and monitoring indicators, with foreign studies further exploring research methods.
Conclusions
In the past decades, weight management methods and specific measures have been a primary focus in this field, with distinct priorities observed between domestic and international scholars. In the future, international exchanges and cooperation should be strengthened, and weight management plans for obese children with Chinese characteristics should be developed according to actual conditions.
10.Association of dietary behaviors, physical activity and altitude with nutritional status among children and adolescents
Chinese Journal of School Health 2025;46(10):1411-1415
Objective:
To analyze the association between altitudes and nutritional status of children and adolescents, and to explore the moderating effects of dietary behaviors and physical activity, so as to provide a scientific basis for developing lifestyle interventions tailored to local conditions.
Methods:
From September to November 2023, physical examinations and questionnaire surveys were conducted among children and adolescents aged 7-17 in two autonomous regions, Inner Mongolia and Xizang, with a final sample of 156 511 participants by the stratified cluster random sampling method. Height and weight were measured to calculate body mass index (BMI). Sociodemographic characteristics, dietary behaviors, and physical activity were collected via questionnaires, while the altitude of each participant s school was obtained using Amap. Logistic regression was performed to examine the relationship between altitudes and nutritional status. Interaction terms and stratified analyses were applied to assess the moderating effects of dietary behaviors and physical activity. Restricted cubic spline (RCS) were used for visualization.
Results:
In 2023, the prevalence of wasting and overweight/obesity among children and adolescents in Xizang were 9.7% and 9.0%, respectively, compared to 2.9% and 22.0% in Inner Mongolia. Logistic regression analysis results showed that for every 1 km increase in altitude, the risk of wasting increased, while the risk of overweight/obesity decreased ( OR =1.43, 0.19, both P <0.05). The results of the stratified analysis showed that compared to those living at altitudes <1 km, children and adolescents with healthy diets showed no significant association between altitudes (1-<2 and 2-<3 km) and wasting ( OR =1.22, 0.75, both P >0.05), whereas significant associations were observed at 3-<4 and ≥4 km altitudes ( OR =2.25, 2.89, both P <0.05). In contrast, unhealthy dietary groups showed statistically significant associations across altitudes ( OR =1.18-4.04, all P <0.05), consistent with RCS results. No moderating effects were observed for physical activity on the altitude wasting association or for dietary behaviors and physical activity combined on the altitude overweight/obesity association ( P interaction =0.63, 0.10, 0.53).
Conclusion
Healthy dietary behaviors play a critical role in improving the nutritional status of children and adolescents and reducing regional disparities, providing a scientific foundation for public health policy formulation and implementation.


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