Abstract Health literate schools (HeLit-Schools) play a significant role in fostering students health literacy. The paper elucidates the background and conceptual connotations of HeLit-Schools, and analyzes how HeLit-Schools effectively integrate and enhance the health literacy of schools in three aspects: philosophy and core drivers, strategy and method implementation, as well as evaluation mechanisms and standard setting. Furthermore, the paper explores the implications of foreign HeLit-Schools research and practice for China under the context of "Healthy China" construction, as well as the key strategies for Chinese schools in the implementation of HeLit-Schools, aiming to provide a new perspective and theoretical support for Chinese schools to practice the "Healthy China initiative" and strengthen school construction from the perspective of health literacy.

Objective:To describe the distribution of fat-free mass (FFM) and fat-free mass index (FFMI) in children aged 3-17 years in China.Methods:Data were collected from National Nutrition and Health Systematic Survey in 0-18 years old children in China. By using multi-stage stratified randomized cluster sampling method, the project was conducted in 28 survey points in urban and rural areas in 14 provinces (autonomous regions and municipalities) in 7 regions in China from 2019 to 2021. FFM was measured using bioelectrical impedance meter. Finally, the body composition data of 70 853 children were included in the analysis. M ( Q1, Q3) was used to describe the gender and age specific FFM and FFMI of the children in different regions. Kruskal-Wallis H rank sum test was used to compare FFM and FFMI of boys and girls in same age group, boys in different age groups, girls in different age groups, as well as boys in same age group and girls in same age group in different regions. DSCF method was used for pairwise comparisons. Results:After the age of 11 years, the difference of FFMI between boys and girls increased year by year. The FFMI was 14.2 kg/m 2 in boys and 13.8 kg/m 2 in girls at 11 years old, the difference was significant ( χ2=135.86, P<0.001). The difference of FFMI between boys and girls exceed 1.0 kg/m 2 from 12 years old, and FFMI was 15.3 kg/m 2 in boys and 14.2 kg/m 2 in girls at 12 year old, the difference was significant ( χ2=597.27, P<0.001). The FFMI was 17.5 kg/m 2 in boys and 14.7 kg/m 2 in girls at 16 years old, the difference was significant ( χ2=2 543.60, P<0.001). The FFMI was higher in boys in northeast China, while the FFMI was lower in both boys and girls in northwest China. Conclusions:Gender specific difference was observed in the increase of FFMI with age. The FFMI was significantly higher in boys than in girls after 11 years old. It is necessary to pay attention to the problem of FFM in children in northeastern and northwestern China.

Objective:To investigate the distribution characteristics of body height, body weight and body mass index (BMI) in children aged 3-17 years in China.Methods:Data were obtained from the National Nutrition and Health Systematic Survey in 0-18 years old children in China. The study selected 70 853 children aged 3-17 years from 28 urban and rural survey sites in 14 provinces (autonomous regions and municipalities) in 7 regions of China with multi-stage stratified cluster random sampling. M ( Q1, Q3) was used to describe the region, age and gender specific body height, body weight and BMI in the children aged 3-17 years. Wilcoxon rank sum test was used to compare the body height, body weight, and BMI between boys and girls in same age group. Kruskal-Wallis H rank sum test was used to compare the body height, body weight and BMI among boys in different age groups and among girls in different age groups, as well as among boys in same age group and among girls in same age group from different regions, and DSCF method was used for further pairwise comparisons. Results:In this study, the median body height and body weight were 172.0 cm and 62.9 kg in 17-year-old boys and 160.0 cm and 53.7 kg in 17-year-old girls. The median for children's body height, body weight, and BMI in most age groups were higher in northeastern and northern China than in southern China, and the differences could be observed until age 17 years. The differences in body weight and BMI in children in northeastern and northern China were greater in Q3 than in Q1 compared with southern China. Conclusions:The body height of children aged 3-17 years continues to increase in China. Northeastern and northern China have more children with higher bodyweight, showing an obvious body weight increase trend, to which close attention needs to be paid.

Objective:To describe the distribution of fat mass (FM), fat mass percentage (FMP), and fat mass index (FMI) in children aged 3-17 years in China.Methods:Data of this study were from the National Nutrition and Health Systematic Survey in 0-18 years old children in China. A total of 70 853 children aged 3-17 years old selected from seven regions of China were included in this analysis. Body composition were measured by using bioelectrical impedance meter. The region, gender and age specific FM, FMP and FMI of the subjects were described by using M ( Q1, Q3). Kruskal-Wallis H rank sum test was used for the comparison of intergroup differences. DSCF method was used for pairwise comparisons. Results:The medians of FM, FMP and FMI were 3.0 kg, 18.3% and 2.9 kg/m 2 in boys aged 3 years and 2.9 kg, 19.0% and 2.9 kg/m 2 in girls aged 3 years, respectively. The FM increased with age and the FMP and FMI decreased with age in both boys and girls aged 3-5 years. After 11 years old, the FM, FMP and FMI decreased first and then increased in boys. From 6-17 years old, the FM, FMP and FMI increased gradually in girls. The FM, FMP and FMI were higher in girls than in boys after 12 years old (all P<0.05). The FM, FMP and FMI were relatively higher in children at the age of 6-14 in northeastern and northern China than in other regions. Conclusions:The age specific FM, FMP and FMI had different changing characteristics in boys and girls aged 3-17 years in seven regions of China. The FM, FMP and FMI also differed with region.

Objective:To analyze the relationship between body mass index (BMI) and fat mass percentage (FMP) in children aged 3-17 years in China.Methods:The BMI and FMP data of children aged 3-17 years from the National Nutrition and Health Systematic Survey in 0-18 years old children in China was analyzed. BMI- Z score/BMI and FMP were used to classify the subjects, respectively. Spearman correlation was used to analyze the correlation between BMI and FMP. The consistency between BMI- Z score/BMI and FMP in classifying the subjects was measured using Kappa coefficient. Results:The FMP of malnutrition, normal and overweight/obesity in boys was higher in age group 10-13-year than in other age groups (all P<0.001). The FMP of all nutritional status in girls increased with age (all P<0.05). The BMI of boys in all the FMP levels increased with age (all P<0.05). When the FMP of girls was 25%- or ≥30%, BMI increased with age (all P<0.001). The relationship between BMI and FMP was strong ( r=0.705, P<0.001), with r of 0.618 in boys and 0.884 in girls. The consistency between BMI- Z score/BMI and FMP in classifying the subjects was found to be moderate (Kappa=0.574, P<0.001). Conclusions:There was a strong relationship between BMI and FMP. The consistency between BMI- Z score/BMI and FMP in classifying the subjects was moderate.

Objective:To evaluate the consistency between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) in the measurement of body composition in children aged 6-17 years in China.Methods:Fat-free mass, fat mass and fat mass percentage were measured by both BIA and DXA in 1 161 children. t-test or Wilcoxon paired test was used to evaluate the different outcome of the two methods. The correlation and consistency between the methods were evaluated by Spearman correlation coefficients ( r) and Bland-Altman analysis. Results:Body compositions measured by BIA was positively correlated with those measured by DXA (fat mass r=0.95, fat-free mass r=0.98, fat mass percentage r=0.86, all P<0.05). Comparing with DXA, BIA underestimate children's fat mass [the mean difference is -3.15 kg, and the SD is 2.35 kg, 95% limits of agreement (LoA): -7.74-1.45 kg] and fat mass percentage (the mean difference is -8.45%, and the SD is 4.63%, 95% LoA: -17.53%-0.64%). Conclusions:Body compositions measured by BIA was highly positively correlated with those measured by DXA. BIA has certain application value in the measurement of body fat mass and fat-free mass of children aged 6-17 years.

【Objective】 To investigate the development of adaptability in children aged 2 - 6, and to explore its influencing factors, so as to provide reference for promoting the development of adaptability in young children. 【Methods】 Data were from the National Nutrition and Health Systematic Survey for Children in China, and 3 319 children aged 2 - 6 and their parents from 28 sites across 14 provinces were recruited in this study.The Development Scale for Children Aged 0 - 6 years (WS/T 580-2017) was used to measure the developmental quotient of children′s adaptive ability, and a survey questionnaire was used to collect relevant information about children and their parents. 【Results】 Among 3 319 children aged 2 - 6, the proportion of slightly low or low level of adaptability, moderate adaptability development, good and excellent adaptability development was 7.68%,66.25% and 26.06%, respectively.The proportion of children aged 5 - 6 with good and excellent adaptability was lower in 3-year-old and 4-year-old groups (χ²=59.29, P<0.05).Multiple stepwise linear regression showed that children′s gender (β=0.06), gestational age of birth (β=-0.05), only child (β=-0.04), left-behind child (β=-0.04), the main caregiver (β=-0.06), and the education level of parents (β=0.09, 0.10), whether parents actively pay attention to children′s emotions (β=-0.06) and whether children play with homemade toys (β=-0.04) were the influencing factors of children′s adaptive development quotient.Girls, full-term children, only children, non-left-behind children, children with parents as main caregivers, parents with a high level of education, parents who often take the initiative to pay attention to children′s emotions, and children who play with homemade toys had a higher level of adaptability development quotient. 【Conclusions】 The development level of adaptability in children aged 2 - 6 in China is mostly above the average level and is related to multiple factors.Targeted intervention work can be carried out on relevant factors in order to promote the development of children′s adaptability.

Abstract As dietary issues of children and adolescents become increasingly complex, the assessment of food literacy (FL) is increasingly importance. FL involves a comprehensive cognition and practical ability concerning food among children, playing a key role in fostering healthy eating habits and improving health levels. The article explores the definition and connotations of FL, and introduces eight FL assessment tools in terms of theoretical foundations, dimensions, assessment methods, and their reliability and validity. Moreover, it provides a comparative analysis of these tools by examining their dimensional design, evaluation indicators, strengths, and weaknesses, as well as their applicable subjects and scenarios, aiming to offer references for implementing relevant policies and developing more comprehensive and effective FL assessment tools.

Objective Investigate the expression level and clinical significance of microRNA-223-3p(miR-223-3p)in the serum of pregnant women with preterm premature rupture of membranes(PPROM).Methods A total of 91 pregnant women who underwent cesarean delivery at the Xuzhou Maternal and Child Health Hospital affiliated with Xuzhou Medical University between April and September 2023 were selected for the study.This included 60 cases of PPROM and 31 cases of term normal pregnant women as the research subjects.The study group was divided based on the pathological results of the membranes into:PPROM group without histological chorioamnionitis(HCA)(PPROM group,n = 37),and PPROM group with HCA(PPROM+HCA group,n = 23).Serum samples from pregnant women were collected before hospital treatment,and the expression level of miR-223-3p in the serum was detected by quantitative real-time PCR(qRT-PCR).The levels of inflammatory factors such as IL-1β,IL-6,IL-8,and TNF-α in the serum were measured by enzyme-linked immunosorbent assay(ELISA).Results The expression level of miR-223-3p in the serum of the PPROM+HCA group was significantly higher than that of the PPROM group and the normal group(P＜0.05).The expression levels of IL-1β,IL-6,IL-8,and TNF-α in the serum of the PPROM+HCA group were also significantly higher than those of the PPROM group and the normal group(P＜0.05).There was a positive correlation between the expression level of miR-223-3p in the serum of the PPROM+HCA group and the expression levels of IL-1β,IL-6,IL-8,and TNF-α(r = 0.553,0.505,0438,0.656,P＜0.05).Conclusion The upregulation of miR-223-3p in the serum of pregnant women with PPROM+HCA is associated with the severity of inflammation in PPROM.

Epidemiological and animal studies indicate that pre-existing diabetes increases the risk of Parkinson's disease(PD).However,the mechanisms underlying this association remain unclear.In the present study,we found that high glucose(HG)levels in the cerebrospinal fluid(CSF)of diabetic rats might enhance the effect of a subthreshold dose of the neurotoxin 6-hydroxydopamine(6-OHDA)on the development of motor disorders,and the damage to the nigrostriatal dopaminergic neuronal pathway.In vitro,HG promoted the 6-OHDA-induced apoptosis in PC12 cells differentiated to neurons with nerve growth factor(NGF)(NGF-PC12).Metabolomics showed that HG promoted hyperglycolysis in neurons and impaired tricarboxylic acid cycle(TCA cycle)activity,which was closely related to abnormal mito-chondrial fusion,thus resulting in mitochondrial loss.Interestingly,HG-induced upregulation of pyruvate kinase M2(PKM2)combined with 6-OHDA exposure not only mediated glycolysis but also promoted abnormal mitochondrial fusion by upregulating the expression of MFN2 in NGF-PC12 cells.In addition,we found that PKM2 knockdown rescued the abnormal mitochondrial fusion and cell apoptosis induced by HG+6-OHDA.Furthermore,we found that shikonin(SK),an inhibitor of PKM2,restored the mito-chondrial number,promoted TCA cycle activity,reversed hyperglycolysis,enhanced the tolerance of cultured neurons to 6-OHDA,and reduced the risk of PD in diabetic rats.Overall,our results indicate that diabetes promotes hyperglycolysis and abnormal mitochondrial fusion in neurons through the upre-gulation of PKM2,leading to an increase in the vulnerability of dopaminergic neurons to 6-OHDA.Thus,the inhibition of PKM2 and restoration of mitochondrial metabolic homeostasis/pathways may prevent the occurrence and development of diabetic PD.