The document clearly establishes this as the U.S.'s number one priority, saying that the U.S. will now "assert and enforce a 'Trump Corollary' to the Monroe Doctrine."

In terms of military presence, they write that this means "a readjustment of our global military presence to address urgent threats in our Hemisphere, and away from theaters whose relative import to American national security has declined in recent decades or years."

On China, a couple of points.

The most striking aspect to me is that China is NOT anymore defined as "the" primary threat, "most consequential challenge," "pacing threat," or similar formulations used in previous such documents.

It's clearly downgraded as a priority. Based on the document's structure and emphasis, the top U.S. priorities could be characterized as:
1) Homeland security and borders (migration, cartels, etc.)
2) Western Hemisphere (Monroe Doctrine restoration)
3) Economic security (reindustrialization, supply chains)
4) China and Indo-Pacific

To be clear they don't define China as an ally or a partner in any shape or form but primarily as
1) an economic competitor;
2) a source of supply chain vulnerabilities (but also a trading partner); and
3) a player who regional dominance should be "ideally" denied because it "has major implications for the U.S. economy."

Interestingly, I believe for the first time ever, they mention the possibility of being overmatched militarily by China:
– They write that "deterring a conflict over Taiwan, ideally by preserving military overmatch, is a priority": "ideally" clearly means that it's ideal, but not necessarily a given. The fact that they call deterring conflict over Taiwan merely "a priority" also suggests, by definition, that it's no more a top strategic priority, or a vital interest.
– On Taiwan they also clearly imply that if the U.S.'s "First Island Chain allies" don't "step up and spend – and more importantly do – much more for collective defense," then there might be "a balance of forces so unfavorable to us as to make defending that island impossible."

They still maintain that "the United States does not support any unilateral change to the status quo in the Taiwan Strait" but, clearly, there's a widening gap between what the US says it opposes and what it's actually willing to do about it.

Interestingly as well, contrary to previous such document, there is zero ideological dimension in the document when it comes to China. No "democracy vs. autocracy" framing, no "rules-based international order" to defend, no values-based crusade. China is treated as a practical issue to be managed, not an ideological adversary to be defeated.