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Considering the adverse effects of agricultural-food systems on both human health and the environment, this research aimed to identify sustainable diets, which are nutritious, culturally acceptable, affordable, and have low environmental impacts, based on self-reported diets in China. Dietary data was collected with a 3-day 24-h dietary recall and weight food record combined method among 10,324 subjects aged 18–64 year, who participated in the China Health Nutrition Survey 2011. Diet quality was assessed by the Chinese Healthy Eating Index 2016 (CHEI2016). Environmental impact was measured by greenhouse gas emissions (GHGE), total water use (TWU), and land use (LU), and diet costs were calculated using market prices of community surveys. Reduced rank regression derived dietary patterns with 34 food groups as predictor variables, and used CHEI2016 score, dietary greenhouse gas emissions (GHGE), total water use (TWU), land use (LU), and cost of the diet as response variables. Four dietary patterns were identified. Participants with the highest adherence (decile 10) to the "High animal-based food" pattern showed higher dietary GHGE (+57%), TWU (+51%), and LU (+54%) and dietary costs (+64%), compared to the average population's diets. The diet in decile 10 for the "High fruit, low ruminant meat" pattern displayed a 21% higher CHEI2016 score, and higher dietary environmental impact (GHGE +17%; TWU +22%; LU +19%) and dietary costs (+46%) than the average diets. Diets of participants who followed the "High fish, low beverages" pattern showed higher environmental impact (GHGE +39%; TWU +32%; LU +28%) and dietary costs (+19%), but the CHEI2016 score was similar (+0.1%). Finally, the "High wheat, low pork" pattern demonstrated lower environmental impacts (GHGE -17%, TWU -12%, LU -2%) and lower cost of the diet (−2%) but also lower CHEI2016 score (−1%) compared to average population. This study reveals the complex trade-offs between diet quality, environmental sustainability, and dietary costs of current dietary patterns. None of the four patterns achieved the desirable combination of high CHEI2016 scores, reduced environmental impact, and reduced dietary costs. The findings offer insights into sustainable diet choices within the current food system, suggesting dietary guidelines should consider environmental sustainability and cost-effectiveness. • Applies reduced rank regression for sustainable dietary pattern assessment. • "High wheat, low pork" pattern reduces environmental impact and costs. • Links dietary patterns to demographics, informing targeted dietary intervention. • Urgent need for explicit sustainability and affordability in dietary guidelines. [ABSTRACT FROM AUTHOR]

A higher diet quality has been associated with lower environmental impacts, but not consistently. Considering the cultural diversity of dietary habits and the heterogeneity of socioeconomic development in China, we aimed to evaluate the association between diet quality and environmental impacts across demographic subgroups and regions. This study used dietary consumption data from the China Health Nutrition Survey 2011. Diet quality was measured with the Chinese Healthy Eating Index 2016 (CHEI2016). Diet-related environmental impact (Greenhouse Gas Emissions (GHGE), Total Water Use (TWU), and Land Use (LU)) were estimated using the Chinese Food Life Cycle Assessment Database. Multilevel regression models were used to quantify the association of the CHEI2016 score and the diet-related environmental impacts across heterogeneous population subgroups. A one-standard deviation increase in CHEI2016 score was associated with an increase of 9.7% in GHGE, 9.1% in TWU, and 6.4% in LU. This occurs because increasing the consumption of under-consumed foods (dairy products and fruit), partially offsets the environmental benefits of reduced meat consumption. Demographic subgroups characterized by either higher educated or a higher income exhibited a larger proportion of animal-based foods within their diet, consequently leading to higher diet-related environmental impacts. When expressed per standard deviation increase in CHEI2016, the dietary environmental impacts rose fastest in the Metropolitan area and slowest in the Northeast. Diets with higher CHEI2016 scores are associated with higher diet-related environmental impacts among Chinese adults but this varies per region. The development of sustainable diet strategies needs to account for potential trade-off between the health and environmental goals, and dietary habits of consumers in different regions and subpopulations. [ABSTRACT FROM AUTHOR]

Background: Controversy persists about whether additional induction chemotherapy (ICT) before neoadjuvant chemoradiation (NCRT) yields improved oncological outcomes. We performed a systematic review and meta-analysis to compare ICT+ NCRT+ surgery(S) with NCRT+ S in patients with locally advanced rectal cancer (LARC)., Methods: We searched the PubMed, EMBASE, Cochrane Library, and China Biology Medicine (CBM) databases. The data were analyzed with Stata version 12.0 software., Results: We identified 9 relevant trials that enrolled 1538 patients. We detected no significant difference in the 5-year overall survival (OS) (OR 1.50, 95% CI 0.48-4.64), disease-free survival (DFS) (OR 1.03, 95% CI 0.73-1.46), local recurrence (LR) (OR 0.80, 95% CI 0.45-1.43), and distant metastasis (DM) rates (OR 1.03, 95% CI 0.55-1.93) between patients who did and did not receive ICT. The addition of ICT before NCRT had a similar pathological complete response rate compared to NCRT (OR 1.26, 95% CI 0.90-1.77). Our findings suggest that between the ICT + NCRT+S and NCRT+S groups, ICT improved the incidence of grade 3 to 4 toxicity effects (OR 4.81, 95% CI 2.38-9.37), but between the ICT + NCRT+S and NCRT+S+ adjuvant chemotherapy (ACT) groups, ICT might reduce toxicity (OR 0.19, 95% CI 0.08-0.50). ICT had no significant impact on surgical complications (OR 0.97, 95% CI 0.63-1.51)., Conclusions: The addition of ICT before NCRT seemingly shows no survival benefit on patients with LARC, and might increase the toxicity.