Mushroom Poisoning Outbreaks — China, 2024

Haijiao Li¹; Yizhe Zhang²; Hongshun Zhang¹; Jing Zhou¹; Zhongfeng Li²; Yu Yin²; Qian He²; Shaofeng Jiang²; Yutao Zhang²; Yuan Yuan¹; Nan Lang²; Bowen Cheng²; Jiaju Zhong²; Mingxuan Yuan²; Zhiyuan Liu²; Chengye Sun^1,#

1. State Key Laboratory of Trauma and Chemical Poisoning, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China;

2. National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Chengye Sun, suncy@chinacdc.cn.

Mushroom poisoning represents a significant food safety concern in China. Over the past decade, China has established an effective mushroom poisoning control and prevention system involving government agencies, clinicians, CDC experts, and mycologists. Since 2019, a series of investigations into mushroom poisoning outbreaks have revealed the spatial and temporal distribution patterns of mushroom poisoning incidents and the diversity of poisonous mushroom species across China. In 2024, the China CDC investigated 599 mushroom poisoning incidents across 28 provincial-level administrative divisions (PLADs), involving 1,486 patients and resulting in 13 deaths, with a case fatality rate of 0.87%. The number of cases per incident ranged from 1 to 14 (median=2), with 11 incidents involving more than 10 patients. Among these cases, 50 patients (including 2 fatalities) from 17 incidents consumed poisonous mushrooms purchased from markets, 37 patients from 14 incidents were poisoned after consuming dried mushrooms, and 15 patients from 10 incidents consumed uncooked wild mushrooms. Temporal analysis revealed that mushroom poisoning incidents occurred throughout the year, with the highest frequency between June and October, peaking in June. Geographically, incidents were reported in 28 PLADs, with 13 PLADs reporting more than 10 incidents. Sichuan, Yunnan, Hunan, Guizhou, and Chongqing were the five most affected regions. Deaths were reported in Guizhou (5 deaths), Sichuan (2 deaths), Chongqing (2 deaths), Heilongjiang (2 deaths), Hunan (1 death), and Jiangsu (1 death). A total of 110 poisonous mushroom species causing 7 distinct clinical syndromes were identified, including 8 newly documented poisonous species, bringing the total number of mushroom species involved in poisoning incidents in China to approximately 246 by the end of 2024. The five most lethal mushrooms were Amanita exitialis, A. molliuscula, A. subpallidorosea, Lepiota brunneoincarnata, and Russula subnigricans, each causing 2 deaths. Chlorophyllum molybdites was responsible for the highest number of poisoning incidents (147 incidents affecting 269 patients). Paxillus obscurosporus, which causes hemolysis, was identified in a poisoning incident for the first time. The persistent severity of mushroom poisoning in China underscores the need for continued public education efforts, strengthened market supervision, and enhanced collaboration across departments and disciplines to reduce the incidence of mushroom poisoning.

蘑菇中毒事件报道 — 中国，2024年

李海蛟¹；章轶哲²；张宏顺¹；周静¹；李钟峰²；尹萸²；何仟²；蒋绍锋²；张驭涛²；袁媛¹；郎楠²；程博文²；钟加菊²；苑明轩²；刘致远²；孙承业^1,#

1. 创伤与化学中毒全国重点实验室，职业卫生与中毒控制所，中国疾病预防控制中心，北京，中国；

2. 职业卫生与中毒控制所，中国疾病预防控制中心，北京，中国。

^# 通信作者：孙承业, suncy@chinacdc.cn。

在中国，蘑菇中毒是一个严峻的食品安全问题。在过去的十余年，一个由政府、临床医生、疾控专业人员和真菌学家组成的蘑菇中毒防控工作网络体系逐步建立起来并发挥了重要作用。2019年以来，我们开展了一系列蘑菇中毒事件的调查，揭示我国蘑菇中毒时空分布格局和毒蘑菇物种多样性。2024年，中国疾病预防控制中心共参与28省份599起蘑菇中毒事件的调查，1486人中毒，13人死亡，整体病死率0.87%。2024年，蘑菇中毒事件中涉及的人数范围为1–14人，中位数为2人，11起事件中毒人数超过10人。这些事件中，17起事件（涉及50人中毒，2人死亡）食用的蘑菇购于市场，14起事件中的37人因食用了干蘑菇引起中毒，另有10起事件中的15人因食用了生蘑菇而引起中毒。月份分布分析，2024年每个月均有蘑菇中毒事件发生，集中在6–10月，6月为最高峰。省份分布分析发现蘑菇中毒事件发生于28省份，13省份报道超过10起事件，四川、云南、湖南、贵州和重庆是中毒事件最多的5个省份，贵州、四川、重庆、黑龙江、湖南和江苏是出现死亡病例的省份，死亡人数分别为5、2、2、2、1和1人。造成7种临床损害类型的110种毒蘑菇发现于2024年的中毒事件中，其中8种为新发现的有毒物种，使发现于中毒事件中的毒蘑菇总数达到246种。造成死亡最多的5种毒蘑菇分别为致命鹅膏（Amanita exitialis）、软托鹅膏（A. molliuscula）、假淡红鹅膏（A. subpallidorosea）、肉褐鳞环柄菇（Lepiota brunneoincarnata）和亚稀褶红菇（Russula subnigricans），分别造成2人死亡。大青褶伞（Chlorophyllum molybdites）依然是造成中毒事件（出现在147起事件中，共造成269人中毒）最多的物种。可以引起溶血型中毒的暗孢桩菇（Paxillus obscurosporus）首次发现于中毒事件中。严峻的蘑菇中毒形势提示我们仍然需要不断努力，开展科普宣传，加强市场监管，密切各部门、多领域合作，为减少蘑菇中毒做出应有贡献。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.106

National Survey on the Prevalence and Geospatial Variation of Body Fat Percentage Among Preschoolers — 31 PLADs, China, 2020

Chenglong Wang¹; Mei Wang¹; Qiang Feng¹; Chaoqun Fan¹; Huiqi Song²; Mingzhe Li¹; Chenhui Xiao¹; Jingjing Wang^1,#

1. National Physical Fitness and Scientific Exercise Research Center, China Institute of Sport Science, Beijing, China;

2. The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

^# Corresponding author: Jingjing Wang, wangjingjing@ciss.cn.

Body fat percentage (BF%) refers to the proportion of adipose tissue relative to total body weight. Compared to body mass index (BMI), BF% demonstrates superior sensitivity in predicting cardiometabolic risk and insulin sensitivity in children. Elevated BF% is associated with multiple adverse health outcomes, including reduced bone mineral density, lower extremity injuries, and systemic inflammation. Despite its clinical significance, comprehensive national data on BF% and its geographical distribution patterns among Chinese preschoolers aged 3 to 6 years remain limited. This study aims to examine BF% prevalence among preschoolers and identify associated factors, while analyzing geospatial variations across the 31 provincial-level administrative divisions (PLADs) to elucidate regional disparities. Data were derived from the 5th Chinese National Physical Fitness Surveillance (CNPFS) conducted in 2020, encompassing 40,222 preschoolers. Geospatial analyses, including hotspot and cold spot identification, were performed using ArcGIS 10.8 software and ArcToolbox with the Hot Spot Analysis (Getis-Ord Gi^*) tool. Results revealed a mean BF% of 20.7% among Chinese preschool children, with females exhibiting significantly higher values (22.1±5.0)% compared to males (19.2±5.4)%. The geographical distribution demonstrated distinct clustering patterns, with hotspots predominantly concentrated in Northeast China and cold spots clustered in southern PLADs. Notably, the distribution of hotspots and cold spots showed symmetrical patterns along China's natural geographical boundaries — the Qinling-Huaihe Line and Bo-Tai Line. Key determinants of preschool children's BF% included sex, parental weight status, education level, and residential environment characteristics. These findings underscore the necessity for targeted interventions to address regional inequalities and promote healthy development among preschoolers.

学龄前儿童体脂率的地理空间分布和流行特征 — 31省份，中国，2020年

王成龙¹；王梅¹；冯强¹；范超群¹；宋慧琦²；李明哲¹；肖辰辉¹；王晶晶^1,#

1.国民体质与科学健身研究中心，国家体育总局体育科学研究所，北京，中国；

2.赛马会公共卫生及基层医疗学系，香港中文大学，香港，中国。

^# 通信作者: 王晶晶，wangjingjing@ciss.cn。

体脂率（Body fat percentage, BF%）反映了脂肪在人体体重中所占的比重，是用于评估超重、肥胖的客观测量指标。相较于身体质量指数（Body mass index, BMI），体脂率在预测儿童心脏代谢风险和胰岛素抵抗方面更加敏感，且与儿童骨密度、下肢损伤等不良健康结局密切相关。学龄前时期（3–6岁）是儿童发育的敏感期，该阶段有过多脂肪积累的儿童在青少年和成年时更易患超重、肥胖。然而，当前我国学龄前儿童体脂率的流行特征以及是否存在显著的地理空间分布差异尚不清晰，本研究旨在探索我国学龄前儿童体脂率的流行特征、地理空间分布特征以及影响因素。数据来自2020年在31个省（自治区/直辖市）开展的全国第五次国民体质监测（CNPFS）横断面调查，研究对象为40,222名3–6岁的学龄前儿童。采用ArcGIS 10.8对全国31个省的儿童体脂率进行冷热点分析，以及Getis-Ord Gi^*探索其聚集趋势，使用多因素回归模型探讨儿童体脂率的影响因素。结果发现，我国学龄前儿童体脂率平均为（20.7±5.4）%，其中男童体脂率为（19.2±5.4）%，女童体脂率为（22.1±5.0）%；我国学龄前儿童体脂率呈现出"北高南低"的地理格局，冷热点聚集趋势显示，我国东北、华北和部分华东地区呈现高体脂率的聚集趋势，而西南和华南地区则为低体脂率的聚集趋势，且这种南北地理格局以我国地理分界线"秦岭-淮河线"和"博乐-台北线"呈对称分布；性别、城乡属性、父母体型和受教育程度、周边环境以及身体活动行为均是影响儿童体脂率的重要因素。我国学龄前儿童的体脂率存在明显的地理格局，未来应增加必要的干预措施旨在减少地区差异，以促进学龄前儿童健康发展。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.107

A Multi-Regional Epidemiological Evaluation on Post-vaccination Serological Testing in Prevention of Vertical Transmission of Hepatitis B Virus — 10 Counties, 5 Provinces, China, 2019–2024

Lin Tang¹; Lun Li²; Lifang Huang³; Jing An⁴; Yang Zhou⁵; Yi Liu⁶; Xiaoxue Liu¹; Qianqian Liu¹; Xiaoqi Wang¹; Siyu Liu¹; Hong Yang¹; Ning Wen¹; Zundong Yin¹; Fuzhen Wang^1,#

1. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease (NITFID), National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China;

2. Department of National Immunization Program, Henan Provincial Center for Disease Control and Prevention, Zhengzhou City, Henan Province, China;

3. Department of National Immunization Program, Fujian Provincial Center for Disease Control and Prevention, Fuzhou City, Fujian Province, China;

4. Department of National Immunization Program, Gansu Provincial Center for Disease Control and Prevention, Lanzhou City, Gansu Province, China;

5. Department of National Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou City, Zhejiang Province, China;

6. Department of National Immunization Program, Sichuan Provincial Center for Disease Control and Prevention, Chengdu City, Sichuan Province, China.

^# Corresponding author: Fuzhen Wang, wangfz@chinacdc.cn.

Infants born to HBsAg-positive mothers are exposed to hepatitis B virus (HBV) during childbirth and require timely hepatitis B vaccination (HepB) and hepatitis B immunoglobulin (HBIG) to prevent vertical transmission. Post-vaccination serological testing (PVST) determines whether HBV-exposed infants are protected, infected, or need revaccination. This study evaluated PVST implementation among HBV-exposed infants and the effectiveness of strategies to prevent mother-to-child transmission (MTCT) of HBV. This observational study of infants born to HBsAg-positive mothers evaluated implementation of the MTCT prevention strategy and PVST follow-up across five provinces in China. Chi-square tests assessed timely HepB1 and HBIG administration and HepB series completion. PVST was used to evaluate MTCT prevention effectiveness. Bivariate analyses explored factors influencing infection and protection rates among HBV-exposed infants. Among 7,425 infants born to HBsAg-positive mothers, 94.8% received timely HepB1 and HBIG, and 99.5% completed the full HepB vaccination series. PVST was conducted in 3,243 (43.68%) infants; the median interval between HepB3 and PVST was 66 days (interquartile range: 47–114). Twenty-six (0.8%) infants tested HBsAg-positive; 3,147 (97.0%) developed protective antibody levels; and 72 (2.2%) were neither infected nor protected, requiring revaccination. Maternal HBeAg positivity was a significant risk factor for MTCT prevention failure (aOR=12.68, 95% CI: 4.72, 34.09). The MTCT prevention strategy demonstrates high effectiveness. PVST for infants born to HBsAg-positive mothers enables evaluation of MTCT prevention strategies and improves their effectiveness. PVST utilization should be expanded to test all HBV-exposed infants to ensure their protection and further enhance the MTCT prevention strategy.

乙肝疫苗免疫后血清学检测在预防乙型肝炎母婴垂直传播中的作用：多区域流行病学评估 — 10县，5省份，中国，2019–2024年

唐林¹；李军²；黄丽芳³；安婧⁴；周洋⁵；刘亿⁶；刘晓雪¹；刘倩倩¹；王晓琪¹；刘斯宇¹；杨宏¹；温宁¹；尹遵栋¹；王富珍^1,#

1. 中国疾病预防控制中心传染病溯源预警与智能决策全国重点实验室，中国疾病预防控制中心免疫规划中心，北京，中国；

2. 河南省疾病预防控制中心免疫规划所，郑州市，河南省，中国；

3. 福建省疾病预防控制中心免疫规划所，福州市，福建省，中国；

4. 甘肃省疾病预防控制中心免疫规划所，兰州市，甘肃省，中国；

5. 浙江省疾病预防控制中心免疫规划所，杭州市，浙江省，中国；

6. 四川省疾病预防控制中心免疫规划所，成都市，四川省，中国。

^# 通信作者：王富珍，wangfz@chinacdc.cn。

乙肝表面抗原 (HBsAg)阳性母亲所生婴儿在分娩过程中暴露于乙型肝炎病毒 (HBV)，需及时接种乙肝疫苗 (HepB)和乙肝免疫球蛋白 (HBIG)以预防垂直传播。乙肝疫苗免疫后血清学检测 (PVST)可判定HBV暴露婴儿的保护状态、感染情况及是否需要再补种。本研究评估HBV暴露婴儿的PVST实施情况及其对预防乙肝母婴传播 (MTCT)策略的效果。通过观察性研究，对五省HBsAg阳性母亲及其婴儿进行MTCT预防策略实施情况和PVST随访评估。采用卡方检验评估首剂乙肝疫苗 (HepB1)和HBIG及时接种率及全程接种完成情况。运用PVST评估MTCT预防效果，通过双变量分析探讨影响HBV暴露婴儿感染率和保护率的因素。在7,425名HBsAg阳性母亲所生婴儿中， HepB1和HBIG及时接种率为94.8%，完成乙肝疫苗全程接种率为99.5%。3,243名 (43.68%)婴儿接受PVST检测，HepB3接种至PVST中位间隔时间为66天 (四分位间距：47-114天)。26名 (0.8%)婴儿检测HBsAg阳性；3,147名 (97.0%)获得保护性抗体水平；72名 (2.2%)未感染但未产生保护性抗体，需要接受再免疫。母亲HBeAg阳性是MTCT预防失败的危险因素 (aOR=12.68，95% CI:4.72, 34.09)。乙肝母婴阻断策略效果显著。对HBsAg阳性母亲所生婴儿开展PVST可有效评估MTCT预防效果，提升策略实施质量。建议加强PVST推广使用，对全部HBV暴露婴儿进行检测以确保其获得免疫保护，进一步完善母婴阻断策略。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.108

A Retrospective Analysis of 112 Mushroom Poisoning Patients — Guangzhou City, Guangdong Province, China, 2016–2023

Yili Zhang¹, Yao Fu³, Haiyuan Zhu⁴, Zhaohuan Luo¹, Lichang Zhong¹, Jingru Lin¹, Xia Wu¹, Xiangyang Cao¹, Wangqiu Deng², Weiwei Liu¹, Zhiqian Yang^1,#

1. Guangzhou Twelfth People's Hospital, Guangzhou City, Guangdong Province, China;

2. Guangdong Institute of Microbiology, Guangzhou City, Guangdong Province, China;

3. The University of Queensland, Brisbane, Queensland, Australia;

4. Jinan University, Guangzhou City, Guangdong Province, China.

^# Corresponding authors: Zhiqian Yang, gz12yy253zyl@gz.gov.cn.

Mushroom poisoning remains a significant food safety concern in China, particularly in southern regions like Guangzhou City, Guangdong Province. Accidental consumption of toxic mushrooms often leads to severe health outcomes, including gastroenteritis, liver failure, renal failure, and psycho-neurological disorders. This study analyzes cases of mushroom poisoning admitted to the Guangzhou Twelfth People's Hospital between 2016 and 2023, focusing on mushroom species, poisoning types, clinical trends, treatment outcomes, and diagnostic challenges. This retrospective study included 112 patients with confirmed mushroom poisoning. Demographic, clinical, and epidemiological data were extracted from medical records, including age, gender, type of mushroom consumed, latency period, symptoms, and treatment outcomes. Statistical analyses examined the relationships between latency period, symptom severity, and hospitalization outcomes. Identification of mushroom species and toxicity classification was supported by the HOPE6 and TALK Chinese clinical assessment protocols. The cohort had a median age of 45 years, with a male-to-female ratio of 1.4:1. May and June were peak months for incidents. Four poisoning types were identified: gastroenteritis (62.5%), liver failure (25.0%), psycho-neurological disorders (9.8%), and renal failure (2.7%). Patients with delayed symptom onset (median latency of 10 hours) experienced more severe complications and prolonged hospital stays. Acute liver failure accounted for all 12 fatalities, predominantly linked to Amanita species. Prompt gastric lavage correlated with lower mortality in gastroenteritis and psycho-neurological cases, while blood purification showed efficacy for renal and liver failure patients. The study underscores the critical role of latency period and initial clinical assessment in determining treatment outcomes for mushroom poisoning. Enhanced diagnostic capabilities and multidisciplinary approaches are essential to reduce mortality. Future efforts should focus on improving mushroom identification protocols and expanding the application of standardized clinical assessment tools like HOPE6 and TALK.

蘑菇中毒112例患者的回顾性分析 — 广州市，广东省，中国，2016–2023年

张伊莉¹；傅尧³；朱海源⁴；罗兆环¹；钟丽嫦¹；林静茹¹；吴霞¹；曹向阳¹；邓旺秋²；刘薇薇¹；杨志前^1,#

1. 广州市第十二人民医院，广州市，广东省，中国；

2. 广东省微生物研究所，广州市，广东省，中国；

3. 昆士兰大学, 布里斯班，昆士兰州，澳大利亚；

4. 暨南大学，广州市，广东省，中国。

^# 通信作者：杨志前，gz12yy253zyl@gz.gov.cn。

蘑菇中毒仍然是中国食品安全的重要问题，尤其是在广州等南部地区。意外食用有毒蘑菇往往导致严重的健康后果，包括胃肠炎、肝衰竭、肾衰竭和精神神经疾病。本研究分析了2016年至2023年期间在广州第十二人民医院收治的蘑菇中毒病例，重点关注蘑菇种类、中毒类型、临床趋势、治疗结果和诊断挑战。本回顾性研究纳入了112例确诊蘑菇中毒患者。从病历中提取了人口统计学、临床和流行病学数据，包括年龄、性别、食用蘑菇种类、潜伏期、症状及治疗结果。统计分析考察了潜伏期、症状严重程度与住院结果之间的关系。蘑菇种类的鉴定和毒性分类依据HOPE6和TALK中文临床评估协议进行。该队列的中位年龄为45岁，男女比例为1.4：1。5月和6月是事件发生率最高的月份。共识别出四种中毒类型：胃肠炎（62.5%）、肝衰竭（25.0%）、精神神经疾病（9.8%）和肾衰竭（2.7%）。症状出现延迟的患者（中位潜伏期为10小时）并发症更为严重，住院时间更长。急性肝衰竭导致了所有12例死亡，主要与致命鹅膏菌属有关。及时进行胃洗在胃肠炎和精神神经疾病病例中的死亡率较低，而血液净化对肾衰竭和肝衰竭患者有效。本研究强调了潜伏期和初始临床评估在确定蘑菇中毒治疗效果中的关键作用。提高诊断能力和多学科联合治疗对于降低死亡率至关重要。未来的工作应集中于改进蘑菇鉴定效率，并扩大标准化临床评估工具如HOPE6和TALK的应用。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.110

Food Education for Infants and Young Children Aged 0–3 Years in China

Qiong Wu^1,&; Shimiao Gong^2,&; Xuening Li¹; Chen Zhao²; Lin Li²; Yiwen Huang^3,#; Yanfeng Zhang^1,#

1. Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China;

2. Beijing KidsHome Children Development Center, Beijing, China;

3. Child Healthcare Center, Capital Center for Children's Health, Capital Medical University, Beijing, China.

^& Joint first authors.

^# Corresponding author: Yiwen Huang,bjk@shouer.com.cn; Yanfeng Zhang, zhangyanfeng@shouer.com.cn.

The concept of Food Education (食育, Shiokuiku), first proposed by Japanese researcher Sagen Ishizuka in 1861, has evolved globally over the years, encompassing food knowledge, healthy dietary behaviors, food preparation, and food safety. Professor Li Lite introduced this concept to China in 2006. This article specifically addresses food education for infants and young children. In 2022, the National Health Commission of China issued Guidelines on Feeding and Nutrition of Infants and Young Children in Nursery Institutions. These guidelines delineate the scope of Food Education for infants and young children as encompassing food cognition, eating behavior, and dietary culture. Early childhood represents a critical period for establishing food preferences and dietary habits. Food education plays a pivotal role in familiarizing infants and young children with new foods and promoting healthy eating patterns. Without structured food education, young children are more susceptible to developing food neophobia and other unhealthy eating habits. We propose strategies to enhance Food Education for infants and young children in China by establishing a comprehensive food education system that leverages multiple channels including families, nursery institutions, early childhood education institutions, and healthcare facilities. Additionally, we emphasize the need for targeted research on food education specifically designed for this age group.

中国0–3岁婴幼儿食育状况

吴琼^1,&；龚诗苗^2,&；李雪宁¹；赵辰²；李琳²；黄艺文^3,#；张延峰^1,#

1. 儿童早期综合发展研究室，首都儿科研究所，北京，中国；

2. 北京宝贝家托育中心，北京，中国；

3. 儿童保健中心，附属首都儿童医学中心，首都医科大学，北京，中国。

^& 共同第一作者。

^# 通讯作者: 黄艺文，bjk@shouer.com.cn；张延峰，zhangyanfeng@shouer.com.cn。

食育（Shiokuiku）概念最早由日本研究者石塚左玄（Sagen Ishizuka）于1861年提出，并在全球范围内逐步发展，涵盖了食物知识、健康饮食行为、食物制作和食品安全等内容。李里特教授于2006年将这一概念首次引入中国。本文专门讨论婴幼儿食育问题。2022年，国家卫生健康委发布了《托育机构婴幼儿喂养与营养指南》。该指南明确指出，婴幼儿食育的范畴包括食物认知、饮食行为和饮食文化。婴幼儿期是建立食物偏好和饮食习惯的关键时期。食育对于婴幼儿了解新食物并促进健康饮食模式起着至关重要的作用。如果缺乏系统的食育，婴幼儿更容易出现食物恐新和其他不健康的饮食习惯。本文提出了改善中国婴幼儿食育的建议，包括利用家庭、托育机构、早期教育机构和医疗保健机构等多方渠道来建立食育体系。同时，也应该开展针对这一年龄段儿童的食育研究。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.109

The iCARE-DM Model for Five-Year T2DM Risk Prediction in the Elderly Population from Chinese Routine Public Health Services — China, 2017–2024

Xinyue Han^1,&; Xiaotao Zhou^2,&; Huifang Yang¹; Qiao Deng³; Wanting Feng¹; Yilin Teng¹; Yanan Wang²; Jialu Yang⁴; Yan Liu⁴; Min Xia⁴; Ben Zhang³; Shouling Wu^5,#; Tao Zhang^3,#; Jiayuan Li^1,#

1. West China Institute of Preventive and Medical Integration for Major Diseases, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu City, Sichuan Province, China;

2. Public Health Service Center, Bao'an District, Shenzhen City, Guangdong Province, China;

3. Department of Epidemiology and Health Statistics, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu City, Sichuan Province, China;

4. Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou City, Guangdong Province, China;

5. Department of Cardiology, Kailuan General Hospital, Tangshan City, Hebei Province, China.

^& Joint first authors.

^# Corresponding authors: Shouling Wu, drwusl@163.com; Tao Zhang, statzhangtao@scu.edu.cn; Jiayuan Li, lijiayuan@scu.edu.cn.

Risk assessment for high-risk populations is critical for preventing T2DM. Although China's public health services have continuously contributed to early grass-roots diagnosis of diabetes for years, universally applicable tools for identifying latent high-risk elderly populations urgently need to account for heterogeneity, robustness, and generalizability. Therefore, this study developed and validated the integrated Chinese Adapted Risk Evaluation for Diabetes Mellitus (iCARE-DM) model for elderly Chinese individuals. The iCARE-DM model was developed based on pooled effect estimates from a meta-analysis of cohort studies that identified T2DM risk factors in East Asian populations and validated in three multicenter Chinese populations. Predictive performance was evaluated using area under the curve (AUC), sensitivity, specificity, accuracy, log-rank tests, and compared with the guideline-recommended model (i.e., New Chinese Diabetes Risk Score, NCDRS) as well as four machine learning (ML) models. The iCARE-DM model achieved AUC values of 0.741, 0.783, and 0.766, outperforming the NCDRS model by at least 12%. Although the best-performing ML model achieved AUC values comparable to the iCARE-DM model, its performance varied significantly across populations (with a range as high as 9%). Subgroup analyses of the iCARE-DM model confirmed consistent performance across age, gender and rural-urban. The iCARE-DM model demonstrated higher accuracy than the NCDRS model and exhibited superior robustness and generalizability compared to the ML models. The iCARE-DM model provides a robust, culturally adapted tool for T2DM risk assessment in elderly Chinese individuals.

基于中国基本公共卫生服务的iCARE-DM模型用于老年人群2型糖尿病五年风险预测 — 中国，2017–2024年

韩昕玥^1,&；周小涛^2,&；杨会芳¹；邓巧³；冯琬婷¹；滕屹霖¹；王雅楠²；杨嘉璐⁴；柳雁⁴；夏敏⁴；张本³；吴寿岭^5,#；张韬^3,#；李佳圆^1,#

1. 重大疾病医防融合研究所，四川大学华西公共卫生学院/华西第四医院，成都市，四川省，中国；

2. 宝安公共卫生服务中心，深圳市，广东省，中国；

3. 流行病与卫生统计学系，四川大学华西公共卫生学院/华西第四医院，成都市，四川省， 中国；

4. 广东省营养膳食与健康重点实验室，营养学系，公共卫生学院，中山大学，广州市，广东省，中国；

5. 开滦总医院心内科，唐山市，河北省，中国。

^& 共同第一作者。

^# 通信作者：吴寿岭，drwusl@163.com；张韬，statzhangtao@scu.edu.cn；李佳圆，lijiayuan@scu.edu.cn。

针对高风险人群开展糖尿病风险评估对2型糖尿病（T2DM）预防至关重要。尽管我国公共卫生服务体系多年来持续推动糖尿病基层早期诊断工作，但现有工具在评估老年潜在高风险人群时仍需解决异质性、稳健性和普适性等关键问题。为此，本研究开发并验证了适用于中国老年人群的糖尿病综合适应风险评估模型（iCARE-DM）。iCARE-DM模型基于东亚人群T2DM危险因素的队列研究Meta分析结果构建，并在中国三个多中心人群中完成验证。通过受试者工作特征曲线下面积（AUC）、灵敏度、特异度、准确率、log-rank检验等指标评估模型预测效能，同时与指南推荐模型（新版中国糖尿病风险评分，NCDRS）及四种机器学习模型进行对比。iCARE-DM模型在三组验证人群中分别获得0.741、0.783和0.766的AUC值，预测效能较NCDRS模型提升至少12%。虽然最优机器学习模型的AUC值与iCARE-DM模型相当，但其在不同人群中的表现差异高达9%。亚组分析证实iCARE-DM模型在年龄、性别和城乡维度均保持稳定预测性能。与NCDRS模型相比，iCARE-DM模型展现出更高的预测准确性；相较于机器学习模型，则具有更优的稳健性和人群普适性。该模型为中国老年人群T2DM风险评估提供了兼具文化适应性和科学可靠性的新型工具。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.111