| Objective:Aim to examine dynamics of transition on social development, diet pattern, nutrition status, physical activities and nutrition related diseases from 1991 to 2009 in Hubei. The risk factors of diabetes were also explored for improvement of nutrition and diabetes prevention.Methods:The data was derived from China health and nutrition survey (CHNS) in Hubei, included adults aged 18-75 years, covering 1169,1097,1159,1103,991,928 and 951 in 1991,1993,1997,2000,2004,2006 and 2009, respectively. In the first part, we developed urbanization index to evaluate neighborhoods eco-social development, METs value to calculate physical activities level, and inflated per capital household income to compare income level among different survey waves. Then we used exploratory factor analysis method (EFA) to obtain dietary pattern. Finally, we demonstrated dynamics of transition on food consumption, nutrition status, dietary pattern, physical activities and nutrition related diseases. In the second part, we conducted correlation analysis between dietary pattern scores and nutrients intake. Then logistic regression model was used to illustrate diabetes risk factors. Results:1. Shift in food consumption in Hubei diet (CHNS,1991-2009):During 1991 and 2009, Hubei saw a profound shift in intake of cereals, from 522.3 g/d to 422.5 g/d (P<0.01). In 2009, cereals intake was 334 g/d,380.4 g/d,384.3 g/d,480.8 g/d, respectively for city, suburban, town and village. Legumes intake decreased from 84 g/d to 24.2 g/d (P<0.01), which valued 19.7 g/d,23.9 g/d,23.8 g/d and 25.7 g/d in 2009 for city, suburban, town and village. Vegetables intake increased from 268.5 g/d to 396.4 g/d (P<0.01), and reached to 344.5 g/d,457.5 g/d,347.4 g/d and 405.5 g/d in 2009 for city, suburban, town and village, respectively. Fruits intake increased from 4.1 g/d to 29.4 g/d (P<0.01), reached to 47.1 g/d, 61.1 g/d,24.6 g/d and 12.9 g/d in 2009 for city, suburban, town and village. Meat intake increased from 46.6 g/d to 73.8 g/d (P<0.01), reached to 98.5 g/d,96.5 g/d,79.3 g/d and 54.9 g/d in 2009 for city, suburban, town and village. Eggs intake increased from 13.3 g/d to 27.2 g/d (P<0.01), reached to 28.2 g/d,19.5 g/d,30.7 g/d and 28.7 g/d in 2009 for city, suburban, town and village. Fish intake increased from 22.3 g/d to 54.8 g/d (P<0.01), reached to 58.8 g/d,91.4 g/d,41.4 g/d and 43.7 g/d in 2009 city, suburban, town and village. Milk intake increased from 0.8 g/d to 2.2 g/d (P<0.01), reached to 5 g/d,2.2 g/d,4.5 g/d and 0.6 g/d in 2009 city, suburban, town and village. Oil intake increased from 38.5 g/d to 47.1 g/d (P<0.01), reached to 42.8 g/d,45.9 g/d,47.7 g/d and 48.6 g/d in 2009 city, suburban, town and village. Salt intake decreased from 13.3 g/d to 8.7 g/d (P<0.01), reached to 8.4 g/d,11.6 g/d,8 g/d and 7.9 g/d in 2009 city, suburban, town and village.2. The energy intakes have decreased over time except for villages (P<0.01). In 2009, energy intake among male adults in city, suburban, town and village populations were 2034.8 kcal/d,2486.0 kcal/d,2410.2 kcal/d and 2782.1 kcal/d, respectively, and that among women were 1798.5 kcal/d,2029.5 kcal/d,2030.5 kcal/d and 2312.2 kcal/d. Proportion of energy from fat increased over time(P<0.01). In 2009, proportion of energy from fat among male groups in city, suburban, town and village were 37.2%,33.0%,32.5% and 29.1%, increased 16.1%,15.5%,10.7%and 5.8%, respectively, compared with 1991. Meanwhile, that among female groups in 2009 among city, suburban, town and village were 37.2%,33.1%,34.0% and 28.1%, increased 15.2%,11.6%,11.9% and 5.7%, respectively, compared with 1991. Proportion of high quality protein increased over time (P <0.01), which reached to 45.9%,43.6%,38.5% and 31.8% among male groups in city, suburban, town and village in 2009, respectively, and 46.1%,42.9%,41.0% and 32.7% among female groups in city, suburban, town and village in 2009, respectively. Proportion of energy from protein among male groups in city, suburban, town and village were 12.6%, 19.2%,11.7% and 11.2%, respectively, and 12.4%,13.6%,12.2% and 11.5% among female groups, in 2009. Results demonstrated that there was not significant change on proportion of energy from protein over time (P>0.05), except increase for male group in suburban.3. We obtained six dietary patterns for male groups in 1997:normal pattern, meat pattern, alcohol pattern, fast food pattern, grain-pickle pattern, vegetarian-alcohol pattern. Seven dietary pattern were derived for female groups in 1997:normal pattern, meat pattern, fast food pattern, milk-legumes-fish pattern, grain-pickle pattern, nut-mushroom pattern, vegetarian-alcohol pattern. We obtained seven dietary patterns for male groups in 2009: normal pattern, fast food pattern, mushroom-legumes pattern, poultry-milk pattern, fruit-meat pattern, egg pattern, alcohol pattern. Six dietary pattern were derived for female groups in 2009:normal pattern, mushroom-legumes-fish pattern, meat-fast food pattern, alcohol pattern, grain-meat-wheat pattern, poultry-milk pattern.4. Physical activity level declined significantly in the past years. MET values (hrs/week) decreased 17% from 1997 to 2009 years among males, while that decreased 35% among females (P<0.01). MET values of professional activities decreased 33% from 1991 to 2009 years among males, while that decreased 57% among females (P<0.01). In 2009, proportion of males who did moderate and heavy physical activities during work time was 57%, which declined 24.3%, compared with 1991 (P<0.01). The proportion of females was 43.9%, which declined 39%, compared with 1991 (P<0.01).5. There was a 5.9 kg weight increase and 1.7kg/m2 BMI increase in male group from 1991 to 2009, while 4.0 kg weight increase and 1.3 kg/m2 BMI increase in female group (P <0.01). Compared with 1991, adjusted rate of overweight/obesity was 37% and 33.1% for male and female in 2009, which was 2.0 and 1.5 times than that in 1991. Adjusted rate of hypertension was 23.7% and 19.4% for male and female in 2009, which was 1.4 and 1.1 times than that in 1991. Adjusted rate of diabetes was 1.71% and 0.75% for male and female in 2009, which was 5 and 2.1 times than that in 1991.6. Univariate logistic regression suggested that income, professional activities, total energy intake, smoke and drinking had no effect on diabetes in neither males nor females.There was no significant relationship between urbanization index and diabetes prevalence rate in males. However, compared with females in communities with urbanization index less than 50, OR value for females who lived in communities with urbanization index more than 70 was 0.37 (95%CI:0.101-0.858). Risk for diabetes increased with age. OR was 2.069 (95%CI:1.212-3.529) in males, while 2.694 (95%CI: 1.427-5.084) in females; risk of diabetes for rural males was 0.3 times (95%CI: 0.107-0.853) than urban males. There was no significant difference on diabetes prevalence in females by area. BMI was positively related with diabetes prevalence in both males and females. Overweight and obesity males had 2.7 times (OR=2.730,95%CI:1.113-6.696) risk being diabetes than normal weight males, and that was 2.2 times (OR=2.239,95%CI: 1.150-5.901) in females. Proportion of energy from fat was positively related with diabetes. It was illustrated that male whose proportion of energy from fat was higher than 35% had 2.3 times (OR=2.279,95%CI:1.717-7.248) being diabetes than those whose proportion of energy from fat was less than 25%, and that was 1.4 times (OR=1.393,95%CI: 1.004-6.489) in females. We also found that males with hypertension had 2.9 times (OR=2.947,95%CI:1.259-6.898) being diabetes than those with normal blood pressure. The similar relation was not found in females.Among dietary patterns in males, pattern2 (fast food pattern) and pattern5 (fruit-meat pattern) were positively related with diabetes risk. Compared with 1st quartiles of pattern2, OR value of the 4th quartiles was 5.385 (95%CI:1.149-25.237); Compared with 1st quartiles of pattern5, OR value of the 4th quartiles was 8.647 (95%CI:1.922-38.898)Among dietary patterns in females, pattern4 (fruit-meat-fast food pattern) was positively related with diabetes risk, while pattern6 (poultry-fruit-milk pattern) was negatively related with diabetes risk. Compared with 1st quartiles of pattern4, OR value of the 3rh quartiles was 2.871 (95%CI:1.060-10.771), and OR value of the 4th quartiles was 3.382 (95%CI:1.711-17.977); Compared with 1st quartiles of pattern6, OR value of the 4th quartiles was 0.321 (95%CI:0.063-0.927)7. Multivariable logistic regression in males demonstrated that diabetes risk increased with age, with OR equaled to 2.087 (95%CI:1.122-3.881); Overweight and obesity males had 2.8 times (OR=2.801,95%CI:1.013-7.216) risk being diabetes than normal weight males. It was found that male whose proportion of energy from fat was higher than 35% had 4.5 times (OR=4.489,95%CI:1.109-18.177) being diabetes than those whose proportion of energy from fat was less than 25%. We also found that males with hypertension had 3.6 times(OR=3.581,95%CI:1.286-9.970)being diabetes than those with normal blood pressure. Compared with 1st quartiles of pattern5, OR value of the 4th quartiles was 8.3 (OR=8.290,95%CI: 1.692-40.629.Multivariable logistic regression in females demonstrated that diabetes risk increased with age, with OR equaled to 3.716 (95%CI:1.363-10.132); It was illustrated that male whose proportion of energy from fat was higher than 35% had 1.6 times (OR=1.627,95%CI: 1.001-3.871) being diabetes than those whose proportion of energy from fat was less than 25%; Compared with 1st quartiles of pattern4, OR value of the 3rh quartiles was 7.503 (95%CI:1.961-58.606), and OR value of the 4th quartiles was 7.550 (95%CI: 1.669-45.227).Conclusions:1. In the past 18 years, Hubei population has great improvement on dietary quality. However,there were problems as well, such as high intake on animal food, oil and salt, and low intake of fruit and milk.2. Dietary structure among different areas changed at different speed, followed from fast to low were city, suburban, town and village.3. Nutritional transition induced to the life style with excessive energy intake, increasing fat intake, lower activity time and activity level, which were all risk factors of obesity, hypertension and diabetes.4. Non-dietary risk factors of diabetes in Hubei population were age, BMI, proportion of energy from fat and hypertension. Dietary risk factors included meat-fruit pattern in males and meat-fast food pattern in females.
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