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.

BACKGROUND: Non-transport unintentional injuries (NTUIs) are major public concerns, especially among children and adolescents in low- and middle-income countries. With environmental and cognitive changes, a recent systematic description of global trends and regional differences concerning NTUIs is urgently needed for the global agenda of relevant policy-making and intervention target findings. METHODS: We used mortality, population, and socio-demographic-index (SDI) data from Global Burden of Disease 2019 to analyze the trends of NTUIs mortality. We applied the slope index of inequality (SII) and relative index of inequality (RII) to measure the absolute and relative inequality between countries and territories. The concentration curve and concentration index (CI) were also used to measure the inequality. We conducted a sensitivity analysis to make our findings credible. RESULTS: In 2019, there were 205,000 deaths due to NTUIs among children and adolescents aged 5 to 24 years, which decreased from 375,000 in 1990. In 2019, the age-standardized mortality rate (ASMR) was 8.13 per 100,000, ranging from the lowest in the Netherlands (0.90 per 100,000) to the highest in the Solomon Islands (29.34 per 100,000). The low-middle SDI group had the highest ASMR of NTUIs, while the low SDI group had the slowest decrease. After excluding the death caused by "exposure to forces of nature" and "other unintentional injuries", drowning accounted for the most deaths in almost every SDI group, gender, and age group, but the major causes of death varied in different subgroups. For example, animal contact was a major cause in low and low-middle SDI groups but less in high SDI groups, while high and high-middle SDI groups had a higher proportion of deaths for foreign body and poisonings. The SII showed a declining trend, but the RII and CI did not, which might indicate that inequality was persistent. Similar results were found in the sensitivity analysis. CONCLUSIONS Despite the declining trend of the mortality rate and the narrowing gap between countries, there were still a large number of children and adolescents dying from NTUIs, and those experiencing social-economic disadvantages remained at high mortality. Embedding the prevention of NTUIs into sustainable development goals might contribute to the progress of reducing death and inequalities, which ensures that no one is left behind.
Global Burden of Disease

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 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 analyze the relationship between insufficient sleep and obesity or central obesity in Chinese Han children and adolescents aged 9-18 years.Methods:A total of 172 710 students who participated in the 2014 Chinese National Survey on Students Constitution and Health with complete data of sleep duration and physical examination, were selected as study subjects. Insufficient sleep was defined, according to the amount of sleep for pediatric populations recommended by the American Academy of Sleep Medicine. Obesity and central obesity of children and adolescents were judged by experts from the Group of China Obesity Task Force and Health Industry Standards in China. Differences between groups were compared by using the t test or χ2 test. Logistic regression method was applied to assess the relationship between insufficient sleep and obesity or central obesity. Results:In 2014, numbers of students with insufficient sleep, obesity and central obesity among Chinese Han children and adolescents aged 9-18 years appeared as 133 410 (77.2 %), 11 145 (6.5 %), and 12 603 (17.8 %), respectively. Among the students with insufficient sleep, 8 358 (6.3 %) were with obesity and 12 244 (17.9 %) were with central obesity. The prevalence of obesity and central obesity among boys with insufficient sleep was higher than that in girls. Pupils with insufficient sleep showed the highest prevalence of obesity and central obesity. After controlling for potential confounders, the risk of obesity appeared an increase of 14.5 % ( OR=1.145, 95 %CI: 1.092-1.200) and the risk of central obesity increased by 12.7 % ( OR=1.127, 95 %CI: 1.078-1.178) in students with insufficient sleep, when compared with those with adequate sleep. Compared with those whose daily sleep duration was less than 6 hours, the ones who slept 7-10 hours per day showed significantly reduction on the risk of obesity and central obesity in students. Conclusions:Insufficient sleep significantly increase the risk of obesity and central obesity in children and adolescents while adequate sleep of 7-10 hours per day would reduce the risk of obesity and central obesity in students.

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.

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 analyze the prevalence of physical fitness among Chinese Han students aged 13-18 years in 2014, and explore related influencing factors. Methods: This study recruited 106 881 Han students aged 13-18 years who had taken physical fitness test from Chinese National Survey on Students' Constitution and Health in 2014. After the exclusion of 1 047 students without complete records of physical fitness test, 105 834 students were included in the final analysis. According to the National Student Physical Health Standard modified in 2014, seven indicators including body mass index, vital capacity, 50-m run, sit-and-reach, standing broad jump, pull-ups/curl-ups and endurance run were tested to calculate the total score of students' physical fitness. Students with score ≥60 were regarded as qualified students. Multivariate non-conditional logistic regression model was used to analyze influencing factors of physical fitness. Results: Among Chinese Han students aged 13-18 years, the total score was 70.1±10.7 and the qualified rate was 83.9% (n=88 813). Boys (83.5% (44 197/52 910)) had a lower qualified rate of physical fitness than girls (84.3% (44 616/52 924)) (P<0.001), and 13-15 age group (86.5% (46 255/53 465)) was higher than the 16–18 age group (81.3% (42 558/52 369)) (P<0.001). Except for 16–18-year-old boys from central region, normal body mass index, eastern region, good socioeconomic status, enough PE class, exercise time ≥1 h/d, homework time ≥2 h/d, TV time <1 h/d were all related to high qualified rates of physical fitness (P<0.05). Conclusion Chinese Han students aged 13-18 years were in good physical condition. The qualified rates of physical fitness were significantly different by gender and age groups. Nutritional status, region, socioeconomic status, PE class, exercise time per day, homework time per day, and TV time per day were related factors of physical fitness.

Objective To explore the association between cesarean section and obesity in child and adolescent.Methods In this study,a total number of 42 758 primary and middle school students aged between 6 and 17 were selected,using the stratified cluster sampling method in 93 primary and middle schools in Hunan,Ningxia,Tianjin,Chongqing,Liaoning,Shanghai and Guangdong provinces and autonomous regions.Log-Binomial regression model was used to analyze the association between cesarean section and obesity in childhood or adolescent.Results Mean age of the subjects was (10.5±3.2) years.The overall rate of cesarean section among subjects attending primary or secondary schools was 42.3％,with 55.9％ in boys and,40.6％ in girls respectively and with difference statistically significant (P＜0.001).The rate on obesity among those that received cesarean section (17.6％) was significantly higher than those who experienced vaginal delivery (10.2％) (P＜0.001).Results from the log-binomial regression model showed that cesarean section significantly increased the risk of obesity in child and adolescent (OR=1.72,95％CI:1.63-1.82;P＜0.001).After adjusting for factors as sex,residential areas (urban or rural),feeding patterns,frequencies of milk-feeding,eating high-energy foods,eating fried foods and the levels of parental education,family income,parental obesity,physical activity levels,gestational age and birth weight etc.,the differences were still statistically significant (OR=1.48,95％ CI:1.39-1.57;P＜0.001).Conclusion The rate of cesarean section among pregnant women in China appeared high which may significantly increase the risk of obesity in child or adolescent.

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.