BackgroundDespite the great burden of chronic respiratory diseases in China, few large multicentre, spirometry-based studies have examined its prevalence, rate of underdiagnosis regionally or the relevance of socioeconomic and lifestyle factors.MethodsWe analysed data from 512 891 adults in the China Kadoorie Biobank, recruited from 10 diverse regions of China during 2004–2008. Air flow obstruction (AFO) was defined by the lower limit of normal criteria based on spirometry-measured lung function. The prevalence of AFO was analysed by region, age, socioeconomic status, body mass index (BMI) and smoking history and compared with the prevalence of self-reported physician-diagnosed chronic bronchitis or emphysema (CB/E) and its symptoms.FindingsThe prevalence of AFO was 7.3% in men (range 2.5–18.2%) and 6.4% in women (1.5–18.5%). Higher prevalence of AFO was associated with older age (p<0.0001), lower income (p<0.0001), poor education (p<0.001), living in rural regions (p<0.001), those who started smoking before the age of 20 years (p<0.001) and low BMI (p<0.001). Compared with self-reported diagnosis of CB/E, 88.8% of AFO was underdiagnosed; underdiagnosis proportion was highest in 30–39-year olds (96.7%) compared with the 70+ age group (81.1%), in women (90.7%), in urban areas (89.4%), in people earning 5K–10 K ¥ monthly (90.3%) and in those with middle or high school education (92.6%).InterpretationIn China, the burden of AFO based on spirometry was high and significantly greater than that estimated based on self-reported physician-diagnosed CB/E, especially in rural areas, reflecting major issues with diagnosis of AFO that will impact disease treatment and management.

Previous research found tobacco smoking and solid fuel use for cooking to increase the risk of chronic liver disease mortality, but previous cohort studies have not investigated their independent and joint associations with liver cancer incidence in contemporary China. The China Kadoorie Biobank (CKB) study recruited 0.5 million adults aged 30 to 79 years from 10 areas across China during 2004 to 2008. Participants reported detailed smoking and fuel use information at baseline. After an 11.1-year median follow-up via electronic record linkage, we recorded 2997 liver cancer cases. Overall, 29.4% participants were current smokers. Among those who cooked at least once per month, 48.8% always used solid fuels (ie, coal or wood) for cooking. Tobacco smoking and solid fuel use for cooking were independently associated with increased risks of liver cancer, with hazard ratios (95% confidence intervals [CIs]) of 1.28 (1.15-1.42) and 1.25 (1.03-1.52), respectively. The more cigarettes consumed each day, the earlier the age of starting smoking or

Background Epidemiological evidence on the relationship between fish consumption and chronic obstructive pulmonary disease (COPD) is limited, especially among Chinese. Objectives To explore the prospective association between fish consumption and COPD among a large population-based Chinese cohort. Methods The China Kadoorie Biobank (CKB) recruited over 0.5 million participants from ten geographically diverse regions across China from 2004 to 2008. Consumption frequency of fish at baseline was assessed by a validated food frequency questionnaire. 169,188 men and 252,238 women who had no prior COPD and other major chronic diseases at baseline were included in our analyses. Cox proportional hazard models were employed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for fish consumption categories in relation to incident COPD. Results During a median follow-up of 11.1 years, 5542 incident COPD cases were documented. Fish consumption was inversely associated with COPD risk among women, with a 17% reduction in risk for participants who consumed fish ≥4 days/week compared with non-consumption (HR: 0.83; 95% CI: 0.70, 0.99; p for trend = 0.017), whereas we did not observe such a dose-response relationship among men (HR: 0.89; 95% CI: 0.76, 1.05; p for trend = 0.373). The joint analysis showed that COPD risk was 38% and 48% lower in men and women who consumed fish ≥4 days/week and had a healthy lifestyle (having ≥4 of the following healthy lifestyle factors: not smoking currently, never or rarely drinking alcohol, adequate physical activity, BMI 18.5-23.9 kg/m2, normal waist circumference, reasonable diet), compared with participants with fish consumption &lt;4 days/week and unhealthy lifestyle (≤1 factors). Conclusion Higher fish consumption was associated with lower COPD risk among Chinese women but not men. Such association was independent of lifestyle factors. Eating adequate fish with an overall healthy lifestyle might help to lower the risk of COPD.

Little is known about the association of sleep duration with hyperuricemia. Especially lacking is evidence from longitudinal studies. Based on the MJ Health Examination Database in Beijing, China, a prospective study was designed. Participants were classed into short, normal, and long groups by sleep duration. The Cox regression model was used to estimate the hazard risk of hyperuricemia for short or long sleep duration compared with the normal group after adjusting for potential confounders. During a median 3.08 years follow-up, 4868 (14.31%) incident hyperuricemia events were documented among 34,025 participants with a crude incidence rate of 39.49 per 1000 persons. Years after adjusting for potential confounders, a 7% higher risk of hyperuricemia in the short sleep duration group (<7 h, 95% confidence interval: 1.01–1.14) and a 15% lower risk in the long sleep duration group (≥8 h, 95%CI: 0.74–0.97) were found compared with the normal group (7–8 h) (p for trend < 0.001). Nevertheless, the association of the short sleep duration group was marginally significant after further adjustment of the count of white blood cells (hazard ratio: 1.07, 95%CI: 1.00 –1.13). Sleep duration was inversely associated with hyperuricemia, which highlights the public health significance of sufficient sleep duration for preventing hyperuricemia.

Objective: The aim of this study was to simultaneously explore the associations of major dietary patterns (DP) with lipid profiles and the associations of these profiles with general and central obesity risks and to evaluate the extent to which the metabolites mediate such associations.Methods: Habitual food consumption of 4778 participants with an average age of 47.0 from the China Kadoorie Biobank was collected using a 12-item food frequency questionnaire. Plasma samples were analyzed via targeted nuclear magnetic resonance (NMR) spectroscopy to quantify 129 lipid-related metabolites. Anthropometric information was measured by trained staff.Results: Two DPs were derived by factor analysis. The newly affluent southern pattern was characterized by high intakes of rice, meat, poultry, and fish, whereas the balanced pattern was characterized by consuming meat, poultry, fish, fresh fruit, fresh vegetables, dairy, eggs, and soybean. The newly affluent southern pattern was positively associated with 45 metabolites, which were positively associated with risks of obesity at the same time. The global lipid profile potentially explained 30.9%, 34.7%, and 53.1% of the effects of this DP on general obesity, waist circumferencedefined central obesity, and waist-hip ratio-defined central obesity, respectively.The members of the Steering Committee and Collaborative Group are listed in online Supporting Information.