Background
Methods
Study design and participants
Data collection
Assessment of diet factors and development of the Chinese HFD index
Food groups | Recommended amount (g) | Share of food group (broad or single) | hf |
---|---|---|---|
Emphases | 1300 | 0.81 | |
Whole grains and legumes | 100 | 0.08 | 0.06 |
Tubers | 75 | 0.06 | 0.05 |
Other vegetables | 225 | 0.17 | 0.14 |
Vitamin A- or vitamin C-rich vegetablesa | 225 | 0.17 | 0.14 |
Fruits | 300 | 0.23 | 0.19 |
Dairyb | 300 | 0.23 | 0.19 |
Soya productsc | 15 | 0.01 | 0.01 |
Nuts and seeds | 10 | 0.01 | 0.01 |
Aquatic products | 50 | 0.04 | 0.03 |
Includes | 275 | 0.17 | |
Refined grains | 150 | 0.55 | 0.09 |
Meat and poultry | 50 | 0.18 | 0.03 |
Eggs | 50 | 0.18 | 0.03 |
Oil | 25 | 0.09 | 0.02 |
Limits | 31 | 0.02 | |
Salt | 6 | 0.19 | 0.00 |
Added sugar | 25 | 0.81 | 0.02 |
Assessment of non-dietary factors
Diagnostic criteria of MetS
No. | Measure | Categorical Cut Points |
---|---|---|
1 | Elevated waist circumference (WC) | ≥90 cm in males; ≥85 cm in females |
2 | Elevated triglycerides (TC) (drug treatment for elevated triglycerides is an alternate indicator) | ≥150 mg/dL (1.7 mmol/L) |
3 | Reduced high-density lipoprotein cholesterol (HDL-C) (drug treatment for reduced HDL-C is an alternate indicator) | <40 mg/dL (1.0 mmol/L) in males;<50 mg/dL (1.3 mmol/L) in females |
4 | Elevated blood pressure (antihypertensive drug treatment in a patient with a history of hypertension is an alternate indicator) | Systolic ≥130 and/or diastolic ≥85 mmHg |
5 | Elevated fasting glucose (drug treatment of elevated glucose is an alternate indicator) | ≥100 mg/dL |
Statistical analysis
Results
Demographic characteristics and the prevalence of MetS and its components
Factor | Group | N | Elevated WC | Elevated fasting glucose | Elevated blood pressure | Elevated TC | Reduced HDL | MetS | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
% | P | % | P | % | P | % | P | % | P | % | P | |||
Total | 1520,100 | 35.3 | 32.9 | 37 | 40.9 | 43.6 | 36.4 | |||||||
Gender | Male | 527,34.7 | 41.2 | <0.001 | 41.7 | <0.001 | 46.1 | <0.001 | 47.2 | <0.001 | 42.5 | 0.548 | 43.5 | <0.001 |
Female | 993,65.3 | 32.1 | 28.2 | 32.2 | 37.5 | 44.1 | 32.7 | |||||||
Age | 18~ 44.9 years | 547,36 | 17.6 | <0.001 | 13.7 | <0.001 | 9.7 | <0.001 | 20.8 | <0.001 | 30.2 | <0.001 | 14.6 | <0.001 |
45~ 54.9 years | 260,17.1 | 36.2 | 24.6 | 26.9 | 40 | 43.5 | 29.2 | |||||||
55~ 64.9 years | 272,17.9 | 48.2 | 46 | 55.5 | 56.6 | 56.3 | 52.6 | |||||||
≥65 years | 441,29.0 | 48.8 | 53.5 | 65.5 | 56.5 | 52.4 | 57.8 | |||||||
Educational attainment | Illiterate | 66,4.3 | 63.6 | <0.001 | 47 | <0.001 | 69.7 | <0.001 | 62.1 | <0.001 | 60.6 | <0.001 | 69.7 | <0.001 |
Middle school or lower | 445,29.3 | 46.5 | 45.4 | 51.9 | 49.4 | 47.4 | 46.3 | |||||||
High school or professional training education | 627,41.3 | 32.7 | 28.4 | 32.4 | 40.4 | 46.1 | 34 | |||||||
Undergraduate education or higher | 378,24.9 | 21.2 | 23 | 21.2 | 28.3 | 32.3 | 23 | |||||||
Drinking behavior | No | 942,68.5 | 36.3 | 0.427 | 34.9 | 0.594 | 41.3 | 0.027 | 44.8 | 0.188 | 45.8 | 0.315 | 39.7 | 0.212 |
Yes | 434,31.5 | 34.1 | 36.4 | 35 | 41 | 42.9 | 36.2 | |||||||
Smoking behavior | Never smoked | 1145,75.3 | 32.3 | <0.001 | 30.2 | <0.001 | 34.4 | <0.001 | 38.4 | 0.002 | 42.4 | 0.066 | 33.1 | <0.001 |
Former smoker | 165,10.9 | 46.1 | 46.7 | 53.3 | 44.8 | 42.4 | 46.1 | |||||||
Current smoker | 210,13.8 | 42.9 | 36.7 | 38.6 | 51 | 51 | 47.1 | |||||||
BMI | <18.5 kg/m2 | 74,4.9 | 0 | <0.001 | 9.5 | <0.001 | 5.4 | <0.001 | 4.1 | <ss0.001 | 12.2 | <0.001 | 4.1 | <0.001 |
18.5~ 24.0 kg/m2 | 739,48.6 | 7 | 26 | 26.9 | 29.8 | 33 | 18.3 | |||||||
24.0~ 28.0 kg/m2 | 538,35.4 | 60.8 | 41.4 | 48.1 | 53.9 | 56.1 | 53.9 | |||||||
≥28.0 kg/m2 | 168,11.1 | 92.9 | 46.4 | 60.1 | 64.3 | 63.7 | 75 | |||||||
Physical activity | Sedentary group | 119,7.8 | 38.7 | 0.095 | 33.6 | 0.008 | 32.8 | 0.001 | 45.4 | 0.132 | 50.4 | 0.169 | 40.3 | 0.092 |
T1 | 468,30.8 | 30.8 | 28.6 | 31 | 36.5 | 41 | 31.8 | |||||||
T2 | 466,30.7 | 36.3 | 31.1 | 38 | 42.7 | 45.9 | 38.6 | |||||||
T3 | 467,30.7 | 37.9 | 38.8 | 43.3 | 42.2 | 42 | 37.9 | |||||||
Energy intake | Q1 | 380,25.0 | 35.8 | 0.964 | 30.3 | 0.121 | 35.3 | 0.647 | 37.6 | 0.485 | 41.3 | 0.71 | 33.7 | 0.639 |
Q2 | 380,25.0 | 35.8 | 35.5 | 35.8 | 41.8 | 44.5 | 37.1 | |||||||
Q3 | 380,25.0 | 34.2 | 29.7 | 37.9 | 42.9 | 45.3 | 37.4 | |||||||
Q4 | 380,25.0 | 35.3 | 36.1 | 39.2 | 41.1 | 43.2 | 37.6 | |||||||
HFD-index | Q1 | 368,24.2 | 33.2 | 0.764 | 29.9 | 0.166 | 36.1 | 0.295 | 38.6 | 0.196 | 37.5 | 0.014 | 35.3 | 0.035 |
Q2 | 410,27.0 | 36.6 | 36.8 | 39 | 41.2 | 46.1 | 37.1 | |||||||
Q3 | 368,24.2 | 35.1 | 27.4 | 33.4 | 38.3 | 41.8 | 31.5 | |||||||
Q4 | 374,24.6 | 36.1 | 36.9 | 39.3 | 45.2 | 48.4 | 41.7 |
Factor | Group | N | Elevated WC | Elevated fasting glucose | Elevated blood pressure | Elevated TC | Reduced HDL | MetS | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
% | P | % | P | % | P | % | P | % | P | % | P | |||
Total | 2398 | 36.2 | 33.1 | 33.3 | 36.2 | 28.1 | 27.3 | |||||||
Gender | Male | 1106 | 37 | 0.485 | 35.5 | 0.018 | 36.7 | <0.001 | 42 | <0.001 | 21.3 | <0.001 | 28.7 | 0.171 |
Female | 1292 | 35.6 | 31 | 30.3 | 31.2 | 33.9 | 26.2 | |||||||
Age | 18~ 44.9 years | 742 | 22.8 | <0.001 | 20.1 | <0.001 | 10 | <0.001 | 32.1 | 0.014 | 28 | 0.935 | 14.3 | <0.001 |
45~ 54.9 years | 608 | 33.7 | 31.7 | 27.1 | 36.3 | 27.6 | 23.8 | |||||||
55~ 64.9 years | 496 | 45.4 | 40.7 | 42.5 | 40.9 | 29.2 | 35.9 | |||||||
≥65 years | 552 | 48.9 | 45.1 | 63 | 37.3 | 27.7 | 40.9 | |||||||
Educational attainment | Illiterate | 192 | 52.1 | <0.001 | 42.7 | <0.001 | 61.5 | <0.001 | 32.8 | 0.311 | 29.2 | 0.929 | 40.6 | <0.001 |
Middle school or lower | 1145 | 40.1 | 37.7 | 36 | 37.8 | 28.6 | 30.9 | |||||||
High school or professional training education | 755 | 28.1 | 26 | 27.3 | 34.3 | 27.7 | 20.4 | |||||||
Undergraduate education or higher | 303 | 32.3 | 27.1 | 20.1 | 37.3 | 27.1 | 22.8 | |||||||
Drinking behavior | No | 1646 | 36.6 | 0.614 | 33.4 | 0.661 | 33.8 | 0.441 | 34 | <0.001 | 30.9 | <0.001 | 27.7 | 0.527 |
Yes | 752 | 35.5 | 32.4 | 32.2 | 41 | 21.9 | 26.5 | |||||||
Smoking behavior | Never smoked | 1735 | 36.7 | 0.788 | 32 | 0.226 | 31.9 | <0.001 | 33.8 | <0.001 | 30.5 | <0.001 | 26.5 | 0.332 |
Former smoker | 83 | 34.9 | 36.1 | 55.4 | 38.6 | 19.3 | 31.3 | |||||||
Current smoker | 580 | 35.2 | 35.7 | 34.1 | 42.9 | 22.1 | 29.1 | |||||||
BMI | <18.5 kg/m2 | 116 | 2.6 | <0.001 | 17.2 | <0.001 | 15.5 | <0.001 | 9.5 | <0.001 | 17.2 | <0.001 | 2.6 | <0.001 |
18.5~ 24.0 kg/m2 | 1221 | 14.2 | 26.9 | 25.6 | 28.3 | 23.8 | 14.9 | |||||||
24.0~ 28.0 kg/m2 | 779 | 56.6 | 38.5 | 41.1 | 45.7 | 30.8 | 37.7 | |||||||
≥28.0 kg/m2 | 264 | 92.8 | 53 | 52.7 | 55.7 | 44.7 | 64.8 | |||||||
Physical activitya | Sedentary group | 1132 | 43.3 | <0.001 | 38.3 | <0.001 | 42.8 | <0.001 | 38.1 | 0.356 | 29.2 | 0.225 | 33.9 | <0.001 |
T1 | 463 | 31.3 | 29.8 | 30.9 | 34.8 | 27.6 | 24.4 | |||||||
T2 | 544 | 28.5 | 27.6 | 20.6 | 34.4 | 28.7 | 20.4 | |||||||
T3 | 258 | 30.6 | 27.9 | 22.9 | 34.5 | 22.9 | 18.2 | |||||||
Energy intakeb | Q1 | 691 | 35.6 | 0.442 | 34.6 | 0.622 | 37.5 | 0.023 | 34.7 | 0.152 | 30 | 0.093 | 28.7 | 0.752 |
Q2 | 678 | 37.5 | 32 | 33.3 | 35.3 | 28.6 | 26.5 | |||||||
Q3 | 580 | 34 | 33.8 | 29.8 | 40.2 | 29 | 27.6 | |||||||
Q4 | 449 | 38.3 | 31.4 | 31.2 | 34.7 | 23.4 | 26.1 | |||||||
HFD-indexc | Q1 | 479 | 40.3 | 0.013 | 36.1 | 0.141 | 31.9 | 0.668 | 39.2 | 0.265 | 25.9 | 0.275 | 28.8 | 0.046 |
Q2 | 519 | 39.5 | 35.3 | 35.1 | 37.6 | 27.6 | 30.3 | |||||||
Q3 | 579 | 35.1 | 31.8 | 34 | 35.2 | 31.1 | 28.3 | |||||||
Q4 | 821 | 32.6 | 30.8 | 32.4 | 34.2 | 27.6 | 23.9 |
Distribution of the Chinese HFD index and its correlations with nutrients
Factor | Group | CUADHS | CHNS | ||
---|---|---|---|---|---|
\( \overline{x}\pm s \)
| P |
\( \overline{x}\pm s \)
| P | ||
Total | 0.41 ± 0.10 | 0.38 ± 0.06 | |||
Gender | Male | 0.38 ± 0.10 | <0.001 | 0.37 ± 0.06 | <0.001 |
Female | 0.42 ± 0.10 | 0.38 ± 0.06 | |||
Age | 18~ 44.9 years | 0.39 ± 0.10 | <0.001 | 0.37 ± 0.06 | 0.001 |
45~ 54.9 years | 0.41 ± 0.10 | 0.38 ± 0.06 | |||
55~ 64.9 years | 0.40 ± 0.10 | 0.38 ± 0.06 | |||
≥65 years | 0.42 ± 0.10 | 0.38 ± 0.07 | |||
Educational attainment | Illiterate | 0.39 ± 0.09 | 0.018 | 0.36 ± 0.06 | <0.001 |
Middle school or lower | 0.40 ± 0.10 | 0.37 ± 0.06 | |||
High school or professional training education | 0.42 ± 0.10 | 0.39 ± 0.07 | |||
Undergraduate education or higher | 0.41 ± 0.10 | 0.41 ± 0.07 | |||
Drinking behavior | Yes | 0.40 ± 0.10 | 0.001 | 0.37 ± 0.06 | <0.001 |
No | 0.42 ± 0.10 | 0.38 ± 0.06 | |||
Smoking behavior | Never smoked | 0.42 ± 0.10 | <0.001 | 0.38 ± 0.06 | <0.001 |
Former smoker | 0.39 ± 0.11 | 0.38 ± 0.07 | |||
Current smoker | 0.37 ± 0.09 | 0.37 ± 0.06 | |||
BMI | <18.5 kg/m2 | 0.40 ± 0.09 | 0.367 | 0.38 ± 0.06 | 0.875 |
18.5~ 24.0 kg/m2 | 0.41 ± 0.10 | 0.38 ± 0.06 | |||
24.0~ 28.0 kg/m2 | 0.41 ± 0.10 | 0.38 ± 0.06 | |||
≥28.0 kg/m2 | 0.40 ± 0.10 | 0.37 ± 0.07 | |||
Physical activitya | Sedentary group | 0.40 ± 0.09 | 0.443 | 0.38 ± 0.06 | <0.001 |
T1 | 0.41 ± 0.10 | 0.38 ± 0.06 | |||
T2 | 0.41 ± 0.10 | 0.38 ± 0.06 | |||
T3 | 0.41 ± 0.10 | 0.37 ± 0.06 | |||
Energy intakeb | Q1 | 0.41 ± 0.10 | <0.001 | 0.38 ± 0.07 | <0.001 |
Q2 | 0.42 ± 0.10 | 0.38 ± 0.06 | |||
Q3 | 0.41 ± 0.09 | 0.38 ± 0.06 | |||
Q4 | 0.39 ± 0.10 | 0.36 ± 0.06 |
Nutrients | Correlation coefficient | ||
---|---|---|---|
Crude | Energy adjusted | ||
Macronutrient | PA(Protein) | −0.027 | 0.047 |
PA(Carbohydrates) | −0.03 | 0.078** | |
Micronutrient | PA(VitaminB1) | 0.016 | 0.044 |
PA(VitaminB2) | 0.288** | 0.280** | |
PA(Niacin) | −0.032 | 0.054* | |
PA(VitaminB6) | 0.172** | 0.072** | |
PA(VitaminB12) | 0.034 | 0.037 | |
PA(Folate) | 0.179** | 0.206** | |
PA(VitaminA) | 0.293** | 0.249** | |
PA(VitaminC) | 0.381** | 0.296** | |
PA(Zn) | 0.075** | 0.015 | |
PA(Ca) | 0.378** | 0.018 | |
PA(Fe) | −0.043 | −0.009 | |
MPA | 0.141** | 0.271** |
Regression analysis of the Chinese HFD index and MetS and its components
Item | Q13 | Q23 | Q33 | Q43 | P-trend |
---|---|---|---|---|---|
Elevated WC | |||||
Crude | 1 | 1.163 (0.865,1.564) | 1.088 (0.802,1.476) | 1.139 (0.841,1.542) | 0.486 |
Model 1a | 1 | 1.047 (0.766,1.431) | 1.069 (0.773,1.477) | 1.002 (0.723,1.387) | 0.951 |
Model 2b | 1 | 1.107 (0.796,1.539) | 0.996 (0.705,1.405) | 0.967 (0.684,1.367) | 0.726 |
Elevated fasting glucose | |||||
Crude | 1 | 1.367 (1.013,1.846) | 0.887 (0.644,1.222) | 1.371 (1.009,1.863) | 0.272 |
Model 1a | 1 | 1.244 (0.898,1.724) | 0.878 (0.621,1.243) | 1.221 (0.869,1.715) | 0.628 |
Model 2b | 1 | 1.270 (0.906,1.780) | 0.844 (0.589,1.210) | 1.216 (0.855,1.730) | 0.726 |
Elevated blood pressure | |||||
Crude | 1 | 1.131 (0.845,1.513) | 0.887 (0.655,1.202) | 1.144 (0.85,1.540) | 0.728 |
Model 1a | 1 | 0.901 (0.640,1.268) | 0.799 (0.559,1.142) | 0.84 (0.589,1.198) | 0.258 |
Model 2b | 1 | 0.908 (0.636,1.297) | 0.764 (0.526,1.110) | 0.812 (0.56,1.177) | 0.183 |
Elevated blood pressure | |||||
Crude | 1 | 1.116 (0.837,1.488) | 0.989 (0.735,1.330) | 1.312 (0.979,1.758) | 0.144 |
Model 1a | 1 | 0.992 (0.730,1.349) | 0.963 (0.701,1.325) | 1.162 (0.845,1.598) | 0.427 |
Model 2b | 1 | 0.931 (0.675,1.283) | 0.932 (0.669,1.299) | 1.127 (0.808,1.573) | 0.52 |
Reduced HDL | |||||
Crude | 1 | 1.425 (1.070,1.899) | 1.199 (0.892,1.612) | 1.563 (1.166,2.095) | 0.012 |
Model 1a | 1 | 1.302 (0.969,1.749) | 1.13 (0.832,1.534) | 1.356 (0.998,1.843) | 0.112 |
Model 2b | 1 | 1.251 (0.914,1.713) | 1.096 (0.792,1.517) | 1.355 (0.978,1.878) | 0.134 |
MetS | |||||
Crude | 1 | 1.079 (0.805,1.446) | 0.843 (0.620,1.145) | 1.31 (0.974,1.762) | 0.244 |
Model 1a | 1 | 0.913 (0.661,1.259) | 0.788 (0.562,1.104) | 1.091 (0.783,1.522) | 0.848 |
Model 2b | 1 | 0.884 (0.631,1.239) | 0.754 (0.529,1.073) | 1.074 (0.757,1.523) | 0.936 |
Item | Q13 | Q23 | Q33 | Q43 | P-trend |
---|---|---|---|---|---|
Elevated WC | |||||
Crude | 1 | 0.846 (0.672,1.067) | 0.710 (0.562,0.899) | 0.664 (0.524,0.841) | <0.001 |
Model 1a | 1 | 0.801 (0.631,1.017) | 0.650 (0.510,0.829) | 0.579 (0.453,0.740) | <0.001 |
Model 2b | 1 | 0.811 (0.638,1.031) | 0.671 (0.525,0.858) | 0.603 (0.470,0.773) | <0.001 |
Elevated fasting glucose | |||||
Crude | 1 | 0.893 (0.704,1.132) | 0.752 (0.591,0.958) | 0.820 (0.645,1.041) | 0.077 |
Model 1a | 1 | 0.859 (0.673,1.096) | 0.704 (0.549,0.903) | 0.744 (0.581,0.954) | 0.013 |
Model 2b | 1 | 0.856 (0.671,1.094) | 0.701 (0.545,0.901) | 0.747 (0.582,0.960) | 0.016 |
Elevated blood pressure | |||||
Crude | 1 | 1.244 (0.98,1.579) | 0.965 (0.756,1.232) | 1.066 (0.837,1.358) | 0.909 |
Model 1a | 1 | 1.214 (0.931,1.584) | 0.839 (0.639,1.101) | 0.883 (0.674,1.157) | 0.101 |
Model 2b | 1 | 1.230 (0.942,1.606) | 0.870 (0.661,1.146) | 0.908 (0.691,1.194) | 0.165 |
Elevated blood pressure | |||||
Crude | 1 | 0.973 (0.772,1.227) | 0.720 (0.568,0.914) | 0.837 (0.662,1.059) | 0.056 |
Model 1a | 1 | 0.985 (0.779,1.245) | 0.733 (0.576,0.933) | 0.869 (0.684,1.104) | 0.117 |
Model 2b | 1 | 0.977 (0.772,1.236) | 0.717 (0.563,0.915) | 0.856 (0.672,1.091) | 0.096 |
Reduced HDL | |||||
Crude | 1 | 1.197 (0.927,1.544) | 1.190 (0.921,1.537) | 1.229 (0.952,1.586) | 0.161 |
Model 1a | 1 | 1.157 (0.894,1.497) | 1.125 (0.868,1.457) | 1.117 (0.862,1.448) | 0.53 |
Model 22 | 1 | 1.161 (0.896,1.503) | 1.095 (0.844,1.422) | 1.094 (0.842,1.422) | 0.677 |
MetS | |||||
Crude | 1 | 1.008 (0.787,1.292) | 0.827 (0.641,1.067) | 0.791 (0.612,1.022) | 0.033 |
Model 1a | 1 | 0.962 (0.744,1.244) | 0.758 (0.582,0.987) | 0.692 (0.530,0.904) | 0.002 |
Model 2b | 1 | 0.964 (0.745,1.247) | 0.757 (0.580,0.987) | 0.698 (0.533,0.914) | 0.003 |