The impact of triglyceride glucose-body mass index on all-cause and cardiovascular mortality in elderly patients with diabetes mellitus: evidence from NHANES 2007-2016

BACKGROUND

The relationship between triglyceride glucose-body mass index (TyG-BMI) index and mortality in elderly patients with diabetes mellitus (DM) are still unclear. This study aimed to investigate the association between TyG-BMI with all-cause and cardiovascular mortality among elderly DM patients in the United States (US).

METHODS

Patients aged over 60 years with DM from the National Health and Nutrition Examination Survey (2007-2016) were included in this study. The study endpoints were all-cause and cardiovascular mortality and the morality data were extracted from the National Death Index (NDI) which records up to December 31, 2019. Multivariate Cox proportional hazards regression model was used to explore the association between TyG-BMI index with mortality. Restricted cubic spline was used to model nonlinear relationships.

RESULTS

A total of 1363 elderly diabetic patients were included, and were categorized into four quartiles. The mean age was 70.0 ± 6.8 years, and 48.6% of them were female. Overall, there were 429 all-cause deaths and 123 cardiovascular deaths were recorded during a median follow-up of 77.3 months. Multivariate Cox regression analyses indicated that compared to the 1st quartile (used as the reference), the 3rd quartile demonstrated a significant association with all-cause mortality (model 2: HR = 0.64, 95% CI 0.46-0.89, P = 0.009; model 3: HR = 0.65, 95% CI 0.43-0.96, P = 0.030). Additionally, the 4th quartile was significantly associated with cardiovascular mortality (model 2: HR = 1.83, 95% CI 1.01-3.30, P = 0.047; model 3: HR = 2.45, 95% CI 1.07-5.57, P = 0.033). The restricted cubic spline revealed a U-shaped association between TyG-BMI index with all-cause mortality and a linear association with cardiovascular mortality, after adjustment for possible confounding factors.

CONCLUSIONS

A U-shaped association was observed between the TyG-BMI index with all-cause mortality and a linear association was observed between the TyG-BMI index with cardiovascular mortality in elderly patients with DM in the US population.

Trends in Dietary Vitamin A Intake Among US Adults by Race and Ethnicity, 2003-2018

This study uses data from the 2003-2004 to 2017-2018 National Health and Nutrition Examination Surveys (NHANES) to assess whether a difference exists in dietary vitamin A intake as a marker of consumption of vitamin A–rich foods among Black, Hispanic, and White adults in the US.

Prevalence Trends of Diabetes Subgroups in the United States: A Data-driven Analysis Spanning Three Decades From NHANES (1988-2018)

CONTEXT

Data-driven diabetes subgroups were proposed as an alternative to address diabetes heterogeneity. However, changes in trends for these subgroups have not been reported.

OBJECTIVE

Here, we analyzed trends of diabetes subgroups, stratified by sex, race, education level, age categories, and time since diabetes diagnosis in the United States.

METHODS

We used data from consecutive NHANES cycles spanning the 1988-2018 period. Diabetes subgroups (mild obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and mild age-related diabetes [MARD]) were classified using validated self-normalizing neural networks. Severe autoimmune diabetes (SAID) was assessed for NHANES-III. Prevalence was estimated using examination sample weights considering bicyclic changes (BCs) to evaluate trends and changes over time.

RESULTS

Diabetes prevalence in the United States increased from 7.5% (95% CI 7.1-7.9) in 1988-1989 to 13.9% (95% CI 13.4-14.4) in 2016-2018 (BC 1.09%, 95% CI 0.98-1.31, P < .001). Non-Hispanic Black people had the highest prevalence. Overall, MOD, MARD, and SIDD had an increase during the studied period. Particularly, non-Hispanic Black people had sharp increases in MARD and SIDD, Mexican Americans in SIDD, and non-Hispanic White people in MARD. Males, subjects with secondary/high school, and adults aged 40-64 years had the highest increase in MOD prevalence. Trends in diabetes subgroups sustained after stratifying time since diabetes diagnosis.

CONCLUSION

Prevalence of diabetes and its subgroups in the United States has increased from 1988 to 2018. These trends were different across sex, ethnicities, education, and age categories, indicating significant heterogeneity in diabetes within the US obesity burden, population aging, socioeconomic disparities, and lifestyle aspects could be implicated in the increasing trends of diabetes in the United States.

Trends in Cardiovascular Risk Factors in US Adults by Race and Ethnicity and Socioeconomic Status, 1999-2018

Importance

After decades of decline, the US cardiovascular disease mortality rate flattened after 2010, and racial and ethnic differences in cardiovascular disease mortality persisted.

Objective

To examine 20-year trends in cardiovascular risk factors in the US population by race and ethnicity and by socioeconomic status.

Design, Setting, and Participants

A total of 50 571 participants aged 20 years or older from the 1999-2018 National Health and Nutrition Examination Surveys, a series of cross-sectional surveys in nationally representative samples of the US population, were included.

Exposures

Calendar year, race and ethnicity, education, and family income.

Main Outcomes and Measures

Age- and sex-adjusted means or proportions of cardiovascular risk factors and estimated 10-year risk of atherosclerotic cardiovascular disease were calculated for each of 10 two-year cycles.

Results

The mean age of participants ranged from 49.0 to 51.8 years and the proportion of women from 48.2% to 51.3% in the surveys. From 1999-2000 to 2017-2018, age- and sex-adjusted mean body mass index increased from 28.0 (95% CI, 27.5-28.5) to 29.8 (95% CI, 29.2-30.4); mean hemoglobin A1c increased from 5.4% (95% CI, 5.3%-5.5%) to 5.7% (95% CI, 5.6%-5.7%) (both P < .001 for linear trends). Mean serum total cholesterol decreased from 203.3 mg/dL (95% CI, 200.9-205.8 mg/dL) to 188.5 mg/dL (95% CI, 185.2-191.9 mg/dL); prevalence of smoking decreased from 24.8% (95% CI, 21.8%-27.7%) to 18.1% (95% CI, 15.4%-20.8%) (both P < .001 for linear trends). Mean systolic blood pressure decreased from 123.5 mm Hg (95% CI, 122.2-124.8 mm Hg) in 1999-2000 to 120.5 mm Hg (95% CI, 119.6-121.3 mm Hg) in 2009-2010, then increased to 122.8 mm Hg (95% CI, 121.7-123.8 mm Hg) in 2017-2018 (P < .001 for nonlinear trend). Age- and sex-adjusted 10-year atherosclerotic cardiovascular disease risk decreased from 7.6% (95% CI, 6.9%-8.2%) in 1999-2000 to 6.5% (95% CI, 6.1%-6.8%) in 2011-2012, then did not significantly change. Age- and sex-adjusted body mass index, systolic blood pressure, and hemoglobin A1c were consistently higher, while total cholesterol was lower in non-Hispanic Black participants compared with non-Hispanic White participants (all P < .001 for group differences). Individuals with college or higher education or high family income had consistently lower levels of cardiovascular risk factors. The mean age- and sex-adjusted 10-year risk of atherosclerotic cardiovascular disease was significantly higher in non-Hispanic Black participants compared with non-Hispanic White participants (difference, 1.4% [95% CI, 1.0%-1.7%] in 1999-2008 and 2.0% [95% CI, 1.7%-2.4%] in 2009-2018]). This difference was attenuated (-0.3% [95% CI, -0.6% to 0.1%] in 1999-2008 and 0.7% [95% CI, 0.3%-1.0%] in 2009-2018) after further adjusting for education, income, home ownership, employment, health insurance, and access to health care.

Conclusions and Relevance

In this serial cross-sectional survey study that estimated US trends in cardiovascular risk factors from 1999 through 2018, differences in cardiovascular risk factors persisted between Black and White participants; the difference may have been moderated by social determinants of health.

Vitamin D Nutritional Status of Chinese Pregnant Women, Comparing the Chinese National Nutrition Surveillance (CNHS) 2015-2017 with CNHS 2010-2012

Optimal vitamin D (vitD) status is beneficial for both pregnant women and their newborns. The aim of this study was to evaluate the vitamin D status of Chinese pregnant women in the latest China Nutrition and Health Surveillance (CNHS) 2015-2017, analyze the risk factors of vitamin D deficiency (VDD), and compare them with those in CNHS 2010-2012. Serum 25 hydroxyvitamin D (25(OH)D) was measured by ELISA method. City type, district, latitude, location, age, vitamin D supplements intake, education, marital status, annual family income, etc., were recorded. The median 25(OH)D concentration was 13.02 (10.17-17.01) ng/mL in 2015-2017, and 15.48 (11.89-20.09) ng/mL in 2010-2012. The vitamin D sufficient rate was only 12.57% in 2015-2017, comparing to 25.17% in 2010-2012. The risk factors of vitamin D inadequacy (25(OH)D < 20 ng/mL) in 2015-2017 were not exactly consistent with that in 2010-2012. The risk factors included season of spring (p < 0.0001) and winter (p < 0.001), subtropical (p < 0.001), median (p < 0.0001) and warm temperate zones (p < 0.0001), the western (p = 0.027) and the central areas (p = 0.041), while vitD supplements intake (p = 0.021) was a protective factor in pregnant women. In conclusion, vitD inadequacy is very common among Chinese pregnant women. We encourage pregnant women to take more effective sunlight and proper vitD supplements, especially for those from the subtropical, warm and medium temperate zones, the western and the central, and in the seasons of spring and winter.

Trends in the prevalence of kidney stones in the United States from 2007 to 2016

The overall prevalence of kidney stones (KS) in the US rose from 3.2% in 1980 to 10.1% in 2016, but the trends in important subgroups have not been reported. We examined the prevalence trends of KS in subgroups of age, sex and race in the US and identified relevant laboratory factors associated with a history of KS using National Health and Nutrition Examination Survey (NHANES) data. We conducted a cross-sectional study among 28,209 US adults aged ≥ 20 years old in the NHANES from 2007 to 2016. We calculated the prevalence of a self-reported history of KS by using weights and standardized to the 2010 US Census population. We also compared relevant laboratory values according to the history of KS. The prevalence of KS decreased from 8.7% in 2007-2008 to 7.2% in 2011-2012 but then increased to 9.0% in 2013-2014 and 10.1% in 2015-2016. However, the overall prevalence of KS increased over 2007-2016 (p-trend = 0.02). Prevalence of KS among men was higher than women. Among men aged 20-79, there were significant quadratic trends in the prevalence of KS. Whereas, the prevalence of KS increased as a linear trend among women aged 20-59 years over 2007-2016. There were no consistent trends in the prevalence of KS by race. The prevalence trend of KS among non-Hispanic whites was 9.8% from 2007 to 2010 then dropped to 7.9% in 2011-2012 and increased to 10.6% in 2013-2014 and 12.1% in 2015-2016. A similar trend was also observed among non-Hispanic blacks. Among Hispanic, the prevalence of KS was 7.6% in 2007-2008 and 7.4% in 2009-2010 and then fluctuated over the next several time periods. For non-Hispanic Asians, the range was 4.4-4.6%. Regarding relevant laboratory factors, after adjusting for sex, race, age, BMI, smoking status, alcohol drinking, history of diabetes and gout, urine albumin-creatinine ratio and serum osmolality were independently associated with the history of KS in women and men. In conclusion, there was substantial variability in KS prevalence across individual 2-year time periods. This variation of period-specific prevalence values emphasizes the importance of looking at long-term trends and using more than a single 2-year cycle in analyses to increase the precision of the estimate. However, there was an overall increase in the prevalence of KS over 2007-2016.

Distinct Prognostic Role of Serum Uric Acid Levels for Predicting All-Cause Mortality Among Chinese Adults Aged 45~75 Years With and Without Diabetes

INTRODUCTION

The current study sought to explore the effect of baseline serum uric acid (SUA) on the risk of all-cause mortality among Chinese adults aged 45~75 years and to determine its interaction relationship with diabetes.

METHODS

The study was designed as a community-based cohort of 4467 adults aged between 45~75 years included in a 6-years follow-up period from 2009 to 2015 years by the China Health and Nutrition Survey (CHNS). Baseline SUA levels were grouped into quartiles and its association on all-cause mortality was explored using multivariate Cox proportional hazards models. Stratified analyses were performed to explore the associations of SUA quartiles with all-cause mortality among diabetic and non-diabetic individuals.

RESULTS

A total of 141 deaths (5.3 per 1000 person-years) were recorded During a follow-up of 26431 person-years. Out of the 141 deaths, 28 deaths (10.1 per 1000 person-years) were reported in the diabetic groups and 113 deaths (4.8 per 1000 person-years) were recorded in the non-diabetic group. An increased risk of all-cause mortality was observed for participants in the first and fourth quartiles compared with the second SUA quartile, (Q1 SUA: aHR=2.1, 95% CI 1.1~4.1; Q4 SUA: aHR=2.1, 95% CI 1.1~4.0). Stratification of participants by diabetes status showed a U-shaped association for non-diabetic individuals. Whereas, declined eGFR, rather than SUA, was an independent risk factor for all-cause mortality in diabetic individuals (aHR=0.7, 95% CI 0.6~1.0).

CONCLUSION

Our study proved that the prognostic role of SUA for predicting all-cause death might be regulated by diabetes. Both low and high SUA levels were associated with increased mortality, supporting a U-shaped association only in non-diabetic individuals. Whereas, renal dysfunction rather than SUA was an independent risk factor for all-cause mortality. Further studies should be conducted to determine the SUA levels at which intervention should be conducted and explore target follow-up strategies to prevent progression leading to poor prognosis.

Trends in Daily Use of Biotin Supplements Among US Adults, 1999-2016

This pharmacoepidemiology study uses NHANES data to characterize the prevalence and trends in use of high-dosage biotin supplementation among US adults between 1999 and 2016.

Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort

BACKGROUND

Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%-60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort.

METHODS AND FINDINGS

A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (β Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08-1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05-1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses.

CONCLUSIONS

In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).

Trends in social inequality in overweight and obesity among adolescents in Denmark 1998-2018

OBJECTIVES

The aim was to analyze trends in overweight and obesity in relation to socioeconomic position among Danish adolescents in the 20-year period 1998-2018.

METHODS

The study used data on self-reported height and weight and parents' occupational social class (OSC) from 11-, 13- and 15-year-old schoolchildren in 1998, 2002, 2006, 2010, 2014 and 2018, n = 22,177. The analyses included absolute social inequality in overweight/obesity (prevalence difference between low and high OSC) and relative social inequality (OR for overweight/obesity).

RESULTS

In the total sample, the prevalence of overweight and obesity was 9.7% and 1.4%, respectively, with significantly higher prevalence in low than high OSC. There were significantly increasing trends in both overweight and obesity 1998-2018 in low OSC and no significant increase in high OSC. The OR for overweight was 1.59 (1.42-1.74) in middle and 2.16 (1.89-2.46) in low OSC, OR for obesity 1.74 (1.29-2.34) in middle and 2.97 (2.15-4.11) in low OSC. Associations were not modified by survey year.

CONCLUSIONS

There was a persistent absolute and relative social inequality in overweight and obesity 1998-2018 among Danish adolescents.

The contribution of obesity to prescription opioid use in the United States

The prevalence of obesity has grown rapidly over the past several decades and has been accompanied by an increase in the prevalence of chronic pain and prescription opioid use. Obesity, through its association with pain, may represent an important contributor to opioid use. This cross-sectional study investigated the relationship between obesity and prescription opioid use among adults aged 35 to 79 years using data from the National Health and Nutrition Examination Survey (NHANES, 2003-2016). Relative to normal weight, body mass indices in the overweight {odds ratio (OR), 1.11 (confidence interval [CI], 0.88-1.39)}, obese I (OR, 1.26 [CI, 1.01-1.57]), obese II (OR, 1.69 [CI, 1.34-2.12]), and obese III (OR, 2.33 [CI, 1.76-3.08]) categories were associated with elevated odds of prescription opioid use. The association between excess weight and opioid use was stronger for chronic opioid use than for use with a duration of less than 90 days (P-value, <0.001). We estimated that 14% (CI, 9%-19%) of prescription opioid use at the population level was attributable to obesity, suggesting there might have been 1.5 million fewer opioid users per year under the hypothetical scenario where obese individuals were instead nonobese (CI, 0.9-2.0 million users). Back pain, joint pain, and muscle/nerve pain accounted for the largest differences in self-reported reasons for prescription opioid use across obesity status. Although interpretation is limited by the cross-sectional nature of the associations, our findings suggest that the obesity epidemic may be partially responsible for the high prevalence of prescription opioid use in the United States.

Factors and help-seeking behaviors associated with depression in Korean adults: Review of data from 2014 and 2016 Korea national health and nutrition examination surveys

As a health problem in Korea, the prevalence of depression is continuously increasing. This study examines factors and help-seeking behaviors associated with depression in Korean adults. Data was extracted from Korea National Health and Nutrition Examination Surveys (2014 and 2016) using the PHQ-9 depression screening instrument. Among 10,459 participants (weighted frequency = 36,418,292) over 19 years old, 7.2% were classified as having depression including depressive symptoms (PHQ-9 scores ≥ 10) or depressive disorders diagnosed by psychiatrists. Among those with depression, 58.6% responded that they had never sought help. Statistically high odds ratios for being at risk for depression include being female, aged 19-39, living alone, low household income, low level of education (middle school or lower), occupation (unemployed/inactive), an ex- or current smoker, having a chronic disease, and being underweight. Statistically low odds ratios for seeking counselling, age ≥ 60 and lower than high household income; for seeing doctor, age 19-39 or ≥60; and for treatment, age 19-39, lower than middle household income, and more than once per week drinking frequency. Overall, there is a need to find persons having these risk factors and to develop tailored strategies that will encourage help-seeking behavior with help-seeking intention.

Food and Beverage Intake From 12 to 23 Months by WIC Status

: media-1vid110.1542/5984243449001PEDS-VA_2018-2274Video Abstract BACKGROUND: In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) revised its food packages to align with updated nutrition science. Understanding how these revisions may impact current consumption patterns could be important.

METHODS

Dietary data from the 2011-2014 NHANES were used to estimate the percentage of children who were aged 12 to 23 months consuming selected food and beverage categories on any given day by age and WIC status (children who were on WIC, those who were eligible for but not receiving WIC benefits, and those who were not eligible for WIC).

RESULTS

Consumption of food and beverage categories differed by WIC status. On a given day, a lower percentage of children who were eligible for but did not receive WIC benefits consumed vegetables (excluding white potatoes; 42.3%) and grains (76.5%) compared with children who were participating in WIC (vegetables [excluding white potatoes]: 60.4%; grains: 85.5%) and those who were not eligible for WIC benefits (vegetables [excluding white potatoes]: 58.1%; grains: 87.2%; P < .05). A lower percentage of both children who were eligible for but not receiving WIC benefits and those who were participating in WIC consumed fruits (57.6% and 70.6%, respectively) and snacks (45.9% and 48.5%, respectively) than those who were not eligible for WIC (fruits: 86.4%; snacks: 69.1%; P < .05). A lower percentage of children who were receiving WIC consumed dairy than children who were not eligible for WIC (91.7% and 97.2%, respectively; P < .05). A higher percentage of those who were receiving WIC consumed 100% juice (70.6%) than children who were eligible for but not receiving WIC (51.6%) and children who were not eligible for WIC (50.8%; P < .05).

CONCLUSIONS

Improving early WIC participation and retention could positively impact some diet-related disparities among young children who are eligible for WIC.

Inverse association between caffeine intake and depressive symptoms in US adults: data from National Health and Nutrition Examination Survey (NHANES) 2005-2006

The objective of this study was to examine the association between caffeine consumption and depressive symptoms. We used data from the 2005-06 National Health and Nutritional Examination Surveys (NHANES). A total of 4737 individuals aged ≥ 18 years who answered the caffeine intake and PHQ-9 questionnaires were selected for this study. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9) with total scores between 0 and 27. Those with PHQ-9 total scores ≥ 10 were considered as having clinically relevant depression. To investigate the association of caffeine intake and PHQ-9 scores, a multiple logistic regression was used in different models. The overall weighted prevalence of depression was 5.5% (4.3% in men and 6.6% in women). After controlling for potential confounders (age, sex, family PIR, education, marital status, disease history, sleep disorders, thyroid problems, physical activity, social support, smoking, total energy, and cholesterol, retinol, vitamin A, beta-carotene, beta-criptoxanthin, vitamin B1, iron, and phosphorus levels), a significant nonlinear inverse association between caffeine consumption and PHQ-9 scores was observed. In conclusion, caffeine's psychostimulant properties appear to protect against depressive symptoms; however, additional prospective studies are required to ascertain whether or not caffeine consumption can lead to a decrease in depressive symptoms.

A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study

BACKGROUND

A person's rate of aging has important implications for his/her risk of death and disease; thus, quantifying aging using observable characteristics has important applications for clinical, basic, and observational research. Based on routine clinical chemistry biomarkers, we previously developed a novel aging measure, Phenotypic Age, representing the expected age within the population that corresponds to a person's estimated mortality risk. The aim of this study was to assess its applicability for differentiating risk for a variety of health outcomes within diverse subpopulations that include healthy and unhealthy groups, distinct age groups, and persons with various race/ethnic, socioeconomic, and health behavior characteristics.

METHODS AND FINDINGS

Phenotypic Age was calculated based on a linear combination of chronological age and 9 multi-system clinical chemistry biomarkers in accordance with our previously established method. We also estimated Phenotypic Age Acceleration (PhenoAgeAccel), which represents Phenotypic Age after accounting for chronological age (i.e., whether a person appears older [positive value] or younger [negative value] than expected, physiologically). All analyses were conducted using NHANES IV (1999-2010, an independent sample from that originally used to develop the measure). Our analytic sample consisted of 11,432 adults aged 20-84 years and 185 oldest-old adults top-coded at age 85 years. We observed a total of 1,012 deaths, ascertained over 12.6 years of follow-up (based on National Death Index data through December 31, 2011). Proportional hazard models and receiver operating characteristic curves were used to evaluate all-cause and cause-specific mortality predictions. Overall, participants with more diseases had older Phenotypic Age. For instance, among young adults, those with 1 disease were 0.2 years older phenotypically than disease-free persons, and those with 2 or 3 diseases were about 0.6 years older phenotypically. After adjusting for chronological age and sex, Phenotypic Age was significantly associated with all-cause mortality and cause-specific mortality (with the exception of cerebrovascular disease mortality). Results for all-cause mortality were robust to stratifications by age, race/ethnicity, education, disease count, and health behaviors. Further, Phenotypic Age was associated with mortality among seemingly healthy participants-defined as those who reported being disease-free and who had normal BMI-as well as among oldest-old adults, even after adjustment for disease prevalence. The main limitation of this study was the lack of longitudinal data on Phenotypic Age and disease incidence.

CONCLUSIONS

In a nationally representative US adult population, Phenotypic Age was associated with mortality even after adjusting for chronological age. Overall, this association was robust across different stratifications, particularly by age, disease count, health behaviors, and cause of death. We also observed a strong association between Phenotypic Age and the disease count an individual had. These findings suggest that this new aging measure may serve as a useful tool to facilitate identification of at-risk individuals and evaluation of the efficacy of interventions, and may also facilitate investigation into potential biological mechanisms of aging. Nevertheless, further evaluation in other cohorts is needed.

Change in Obesity Prevalence among New York City Adults: the NYC Health and Nutrition Examination Survey, 2004 and 2013-2014

The objective of this study was to measure change in obesity prevalence among New York City (NYC) adults from 2004 to 2013-2014 and assess variation across sociodemographic subgroups. We used objectively measured height and weight data from the NYC Health and Nutrition Examination Survey to calculate relative percent change in obesity (≥ 30 kg/m2) between 2004 (n = 1987) and 2013-2014 (n = 1489) among all NYC adults and sociodemographic subgroups. We also examined changes in self-reported proxies for energy imbalance. Estimates were age-standardized and statistical significance was evaluated using two-tailed T tests and multivariable regression (p < 0.05). Between 2004 and 2013-2014, obesity increased from 27.5 to 32.4% (p = 0.01). Prevalence remained stable and high among women (31.2 to 32.8%, p = 0.53), but increased among men (23.4 to 32.0%, p = 0.002), especially among non-Latino White men and men age ≥ 65 years. Black adults had the highest prevalence in 2013-2014 (37.1%) and Asian adults experienced the largest increase (20.1 to 29.2%, p = 0.06), especially Asian women. Foreign-born participants and participants lacking health insurance also had large increases in obesity. We observed increases in eating out and screen time over time and no improvements in physical activity. Our findings show increases in obesity in NYC in the past decade, with important sociodemographic differences.

Effect of duration of diabetes on bone mineral density: a population study on East Asian males

BACKGROUND

The aim of the present study is to evaluate the association between BMD and type 2 DM status in middle-aged and elderly men. To investigate a possible correlation, the present study used the BMD dataset of the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011.

METHODS

In total, 37,753 individuals participated in health examination surveys between 2008 and 2011. A total of 3383 males aged ≥50 years were eligible. They underwent BMD measurement through dual-energy X-ray absorptiometry (DXA). The fasting plasma glucose and insulin levels of participants were also measured.

RESULTS

Men with prediabetes and diabetes had significantly higher mean BMD at all measured sites than control men did, irrespective of DM status. This was confirmed by multivariable linear regression analyses. DM duration was an important factor affecting BMD. Patients with DM for > 5 years had lower mean BMD in the total hip and femoral neck than those with DM for ≤5 years. Per multivariable linear regression analyses, patients with DM for > 5 years had significantly lower mean BMD at the femoral neck than those with DM ≤5 years.

CONCLUSIONS

DM duration was significantly associated with reduced femoral neck BMD.

Comparison of osteoporosis in US adults with type 1 and type 2 diabetes mellitus

PURPOSE

We examined bone mineral density (BMD) and osteoporosis prevalence in those with type 1 compared to type 2 diabetes derived from a nationally representative sample from the civilian community in the United States.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) for 2005-2006, 2007-2008, 2009-2010, and 2013-2014 were merged to obtain a large sample of diabetics at least 20 years of age with participation in the interview and medical examination. Osteoporosis status was defined by BMD at the total femur, femoral neck, or total lumbar spine. Self-reported diabetics that were prescribed insulin within the first year of diagnosis, are currently taking insulin, and reported no prescriptions for any diabetic pills were classified as type 1. Remaining self-reported diabetics were deemed as having type 2.

RESULTS

A total of 2050 diabetics were included in which 87 (4%) were classified as type 1. Type 1 diabetics were found to have a significantly lower BMD at the total femur and femoral neck, but not at the lumbar spine in the adjusted models. Diabetics with type 1 were 4.7 times more likely to have osteoporosis than those with type 2. There was no significant relationship between diabetes type and BMD or osteoporosis prior to adjustment for confounders.

CONCLUSIONS

Although our results show an increased likelihood of osteoporosis among those with type 1 diabetes, future studies including a larger sample from a community population are needed. It may benefit diabetics, especially those with type 1, to initiate osteoporosis screening methods including evaluation of fracture risk, bone quality, and BMD measurements at multiple sites earlier than recommended.

Sugar-sweetened beverage intake and serum testosterone levels in adult males 20-39 years old in the United States

BACKGROUND

This population-based study was designed to investigate whether consumption of sugar-sweetened beverages (SSB) is associated with lower serum total testosterone concentration in men 20-39 years old.

METHODS

All data for this study were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. The primary outcome was serum testosterone concentration, and main independent variable was SSB intake. Other variables included age, race/ethnicity, poverty/income ratio, body mass index (BMI), serum cotinine, heavy drinking, and physical activity.

RESULTS

Among all subjects (N = 545), 486 (90.4%) had normal testosterone levels (defined as ≥231 ng/dL) and 59 (9.6%) had low testosterone levels (defined as < 231 ng/dL). Multivariate logistic regression revealed the odds of low testosterone was significantly greater with increasing SSB consumption (Q4 [≥442 kcal/day] vs. Q1 [≤137 kcal/day]), adjusted odds ratio [aOR] = 2.29, p = 0.041]. After adjusting for possible confounding variables, BMI was an independent risk factor for low testosterone level; subjects with BMI ≥ 25 kg/m² had a higher risk of having a low testosterone level than those with BMI < 25 kg/m² (aOR = 3.68, p = 0.044).

CONCLUSION

SSB consumption is significantly associated with low serum testosterone in men 20-39 years old in the United States.

Obesity, Metabolic Syndrome, and Cardiovascular Risk in Gluten-Free Followers Without Celiac Disease in the United States: Results from the National Health and Nutrition Examination Survey 2009-2014

BACKGROUND

Despite unclear benefits of gluten-free diets (GFD) in the general population, gluten-free followers without medical indications are driving the market. Few studies have investigated health benefits of GFD in the general population.

AIMS

To estimate metabolic and cardiovascular disease (CVD) risk profiles among gluten-free followers without celiac disease (CD).

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2009-2014. There were 13,523 persons without CD who had GFD information. People with known CVD were excluded. We compared gluten-free followers without CD and the general population by selective metabolic and CVD risk profiles using survey-weighted generalized logistic regression.

RESULTS

There were 155 gluten-free followers without CD and CVD, corresponding to a weighted prevalence of 1.3% (3.2 million Americans). Gluten-free followers tended to be women and have a smaller waist circumference and higher HDL cholesterol. They also had a lower BMI with a borderline p value (0.053) and significant self-reported weight loss (-1.33 kg) over one year. Moreover, gluten-free followers were more likely to consider their weight appropriate. There was no statistical difference by age, smoking, hypertension, total cholesterol, triglyceride cholesterol, HbA1c, or fasting glucose. Despite a lower probability of having metabolic syndrome (33.0 vs 38.5%) and lower 10-year CVD risk score (4.52 vs 5.70%) in gluten-free followers, there was no statistical difference.

CONCLUSIONS

Although being on a GFD may be beneficial in weight management, there was no significant difference in terms of prevalence of metabolic syndrome and CVD risk score in gluten-free followers without CD.

Trends and variability in blood lead concentrations among US adults aged 20-64 years and senior citizens aged ≥65 years

Using data from National Health and Nutrition Examination Survey for the period 2003-2012, the objective of this study was to evaluate trends in blood lead levels (BLL) among adults aged 20-64 years (adults) and seniors aged ≥65 years (seniors). In addition, the contribution of other factors like gender, race/ethnicity, smoking, and exposure to secondhand smoke at home in explaining variability in BLL was also evaluated by fitting regression models with log10 transformed values of BLL as dependent variables. BLL decreased over 2003-2012 (p < 0.01). Irrespective of gender, race/ethnicity, and smoking status, seniors were found to have higher BLL than adults. Based on the magnitude of differences between the 5th and 95th percentiles, variability in the levels of blood lead was found to be substantially higher among seniors than among adults. Males had statistically significantly higher adjusted BLL than females (2.32 vs. 1.76 μg/dL for seniors, p < 0.01 and 1.66 vs. 1.13 μg/dL for adults, p < 0.01). Non-Hispanic whites had statistically significantly lower adjusted BLL than non-Hispanic blacks (1.99 vs. 2.42 μg/dL for seniors, p < 0.01 and 1.22 vs. 1.42 μg/dL for adults, p < 0.01). When compared with non-smokers, smokers had statistically significantly higher BLL (2.19 vs. 1.86 μg/dL for seniors, p < 0.01 and 1.54 vs. 1.22 μg/dL for adults, p < 0.01). Non-obese had statistically significantly higher BLL than obese individuals (2.11 vs. 1.93 μg/dL for seniors, p < 0.01 and 1.48 vs. 1.27 μg/dL for adults, p < 0.01). Exposure to secondhand smoke at home (SHS) was associated with statistically significantly higher BLL than when there was no exposure to SHS (β = 0.0683, p = 0.03 for seniors; β = 0.034, p = 0.034, p < 0.01 for adults).

Diabetes and fracture risk in older U.S. adults

OBJECTIVE

We examined the diabetes-fracture relationship by race/ethnicity, including the link between pre-diabetes and fracture.

RESEARCH DESIGN AND METHODS

We used Medicare- and mortality-linked data for respondents aged 65years and older from the third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2004 for three race/ethnic groups: non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Mexican Americans (MA). Diabetes was defined as diagnosed diabetes (self-reported) and diabetes status: diagnosed and undiagnosed diabetes (positive diagnosis or hemoglobin A1c (A1C)≥6.5%); pre-diabetes (no diagnosis and A1C between 5.7% and 6.4%); and no diabetes (no diagnosis and A1C<5.7%). Non-skull fractures (n=750) were defined using published algorithms. Hazards ratios (HRs) were calculated using Cox proportional hazards models.

RESULTS

The diabetes-fracture relationship differed significantly by race/ethnicity (pinteraction<0.05). Compared to those without diagnosed diabetes, the HRs for those with diagnosed diabetes were 2.37 (95% CI 1.49-3.75), 1.87 (95% CI 1.02-3.40), and 1.22 (95% CI 0.93-1.61) for MA, NHB, and NHW, respectively, after adjusting for significant confounders. HRs for diagnosed and undiagnosed diabetes were similar to those for diagnosed diabetes alone. Pre-diabetes was not significantly related to fracture risk, however. Compared to those without diabetes, adjusted HRs for those with pre-diabetes were 1.42 (95% CI 0.72-2.81), and 1.20 (95% CI 0.96-1.51) for MA and NHW, respectively. There were insufficient fracture cases to examine detailed diabetes status in NHB.

CONCLUSIONS

The diabetes-fracture relationship was stronger in MA and NHB. Pre-diabetes was not significantly associated with higher fracture risk, however.

Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010

BACKGROUND

Sugar-sweetened beverages (SSBs) are consumed globally and contribute to adiposity. However, the worldwide impact of SSBs on burdens of adiposity-related cardiovascular diseases (CVDs), cancers, and diabetes mellitus has not been assessed by nation, age, and sex.

METHODS AND RESULTS

We modeled global, regional, and national burdens of disease associated with SSB consumption by age/sex in 2010. Data on SSB consumption levels were pooled from national dietary surveys worldwide. The effects of SSB intake on body mass index and diabetes mellitus, and of elevated body mass index on CVD, diabetes mellitus, and cancers were derived from large prospective cohort pooling studies. Disease-specific mortality/morbidity data were obtained from Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We computed cause-specific population-attributable fractions for SSB consumption, which were multiplied by cause-specific mortality/morbidity to compute estimates of SSB-attributable death/disability. Analyses were done by country/age/sex; uncertainties of all input data were propagated into final estimates. Worldwide, the model estimated 184 000 (95% uncertainty interval, 161 000-208 000) deaths/y attributable to SSB consumption: 133 000 (126 000-139 000) from diabetes mellitus, 45 000 (26 000-61 000) from CVD, and 6450 (4300-8600) from cancers. Five percent of SSB-related deaths occurred in low-income, 70.9% in middle-income, and 24.1% in high-income countries. Proportional mortality attributable to SSBs ranged from <1% in Japanese >65 years if age to 30% in Mexicans <45 years of age. Among the 20 most populous countries, Mexico had largest absolute (405 deaths/million adults) and proportional (12.1%) deaths from SSBs. A total of 8.5 (2.8, 19.2) million disability-adjusted life years were related to SSB intake (4.5% of diabetes mellitus-related disability-adjusted life years).

CONCLUSIONS

SSBs are a single, modifiable component of diet that can impact preventable death/disability in adults in high-, middle-, and low-income countries, indicating an urgent need for strong global prevention programs.

The future burden of CKD in the United States: a simulation model for the CDC CKD Initiative

BACKGROUND

Awareness of chronic kidney disease (CKD), defined by kidney damage or reduced glomerular filtration rate, remains low in the United States, and few estimates of its future burden exist.

STUDY DESIGN

We used the CKD Health Policy Model to simulate the residual lifetime incidence of CKD and project the prevalence of CKD in 2020 and 2030. The simulation sample was based on nationally representative data from the 1999 to 2010 National Health and Nutrition Examination Surveys.

SETTING & POPULATION

Current US population.

MODEL, PERSPECTIVE, & TIMELINE

Simulation model following up individuals from current age through death or age 90 years.

OUTCOMES

Residual lifetime incidence represents the projected percentage of persons who will develop new CKD during their lifetimes. Future prevalence is projected for 2020 and 2030.

MEASUREMENTS

Development and progression of CKD are based on annual decrements in estimated glomerular filtration rates that depend on age and risk factors.

RESULTS

For US adults aged 30 to 49, 50 to 64, and 65 years or older with no CKD at baseline, the residual lifetime incidences of CKD are 54%, 52%, and 42%, respectively. The prevalence of CKD in adults 30 years or older is projected to increase from 13.2% currently to 14.4% in 2020 and 16.7% in 2030.

LIMITATIONS

Due to limited data, our simulation model estimates are based on assumptions about annual decrements in estimated glomerular filtration rates.

CONCLUSIONS

For an individual, lifetime risk of CKD is high, with more than half the US adults aged 30 to 64 years likely to develop CKD. Knowing the lifetime incidence of CKD may raise individuals' awareness and encourage them to take steps to prevent CKD. From a national burden perspective, we estimate that the population prevalence of CKD will increase in coming decades, suggesting that development of interventions to slow CKD onset and progression should be considered.

Trends in blood mercury concentrations and fish consumption among U.S. women of reproductive age, NHANES, 1999-2010

BACKGROUND

Consumption of finfish and shellfish is the primary exposure pathway of methylmercury (MeHg) in the US. MeHg exposure in utero is associated with neurodevelopmental and motor function deficits. Regulations and fish advisories may contribute to decreased exposure to mercury over time.

OBJECTIVES

Combine fish tissue mercury (FTHg) concentrations and 1999-2010 NHANES blood mercury concentrations and fish consumption data to investigate trends in blood mercury concentrations, fish consumption, and mercury intake in women of reproductive age.

METHODS

Blood MeHg was calculated from the blood total and inorganic concentrations. Dietary datasets were combined to estimate 30-day fish consumption, then combined with FTHg concentrations to estimate mercury intake and mercury concentration in the fish consumed. Non-linear and logistic regression analyses were used to evaluate trends over time.

RESULTS

Regression analysis found NHANES 1999-2000 to have higher blood MeHg concentrations than the mean of the later releases (p<0.0001) and a positive quadratic trend since 2000 (p=0.004). No trend was observed in fish consumption amount or mercury intake. A decreasing trend was found in the ratio of mercury intake to fish consumed (p=0.04).

CONCLUSIONS

The analyses found blood MeHg concentrations in NHANES 1999-2000 to be significantly higher than the mean of the later releases. There was no trend in fish consumption amount across the study period. The analysis found a decreasing trend in the ratio of mercury intake to fish consumed, consistent with women shifting their consumption to fish with lower mercury concentrations.

Trends in caffeine intake among U.S. children and adolescents

BACKGROUND AND OBJECTIVE

Physicians and policy makers are increasingly interested in caffeine intake among children and adolescents in the advent of increasing energy drink sales. However, there have been no recent descriptions of caffeine or energy drink intake in the United States. We aimed to describe trends in caffeine intake over the past decade among US children and adolescents.

METHODS

We assessed trends and demographic differences in mean caffeine intake among children and adolescents by using the 24-hour dietary recall data from the 1999-2010 NHANES. In addition, we described the proportion of caffeine consumption attributable to different beverages, including soda, energy drinks, and tea.

RESULTS

Approximately 73% of children consumed caffeine on a given day. From 1999 to 2010, there were no significant trends in mean caffeine intake overall; however, caffeine intake decreased among 2- to 11-year-olds (P < .01) and Mexican-American children (P = .003). Soda accounted for the majority of caffeine intake, but this contribution declined from 62% to 38% (P < .001). Coffee accounted for 10% of caffeine intake in 1999-2000 but increased to nearly 24% of intake in 2009-2010 (P < .001). Energy drinks did not exist in 1999-2000 but increased to nearly 6% of caffeine intake in 2009-2010.

CONCLUSIONS

Mean caffeine intake has not increased among children and adolescents in recent years. However, coffee and energy drinks represent a greater proportion of caffeine intake as soda intake has declined. These findings provide a baseline for caffeine intake among US children and young adults during a period of increasing energy drink use.

Cardiovascular health metrics and accelerometer-measured physical activity levels: National Health and Nutrition Examination Survey, 2003-2006

OBJECTIVE

To determine whether relationships exist between accelerometer-measured moderate-to-vigorous physical activity (MVPA) and other cardiovascular (CV) health metrics in a large sample.

PATIENTS AND METHODS

Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) collected from January 1, 2003, through December 31, 2006, were used. Overall, 3454 nonpregnant adults 20 years or older who fasted for 6 hours or longer, with valid accelerometer data and with CV health metrics, were included in the study. Blood pressure (BP), body mass index (BMI), smoking status, diet, fasting plasma glucose level, and total cholesterol level were defined as ideal, intermediate, and poor on the basis of American Heart Association criteria. Results were weighted to account for sampling design, oversampling, and nonresponse.

RESULTS

Significant increasing linear trends in mean daily MVPA were observed across CV health levels for BMI, BP, and fasting plasma glucose (P<.001). Those with a poor BMI and BP had significantly lower mean daily MVPA than those with intermediate and ideal BMIs and BPs (all P<.001). In addition, individuals with an intermediate fasting plasma glucose level had significantly lower mean daily MVPA than individuals at the ideal levels (P<.001). No significant linear trends were observed for cholesterol, smoking, and diet. A significant linear trend was observed for mean daily MVPA and the overall number of other CV health metrics (P<.001).

CONCLUSION

Objectively measured MVPA was related to other CV health metrics in this large sample. These results support the inclusion of physical activity in the overall definition of ideal CV health.

Trends in intakes and sources of solid fats and added sugars among U.S. children and adolescents: 1994-2010

BACKGROUND

There are increasing global concerns about improving the dietary intakes of children and adolescents. In the United States (U.S.), the focus is on reducing energy from foods and beverages that provide empty calories from solid fats and added sugars (SoFAS).

OBJECTIVE

We examine trends in intakes and sources of solid fat and added sugars among U.S. 2-18 year olds from 1994 to 2010.

METHODS

Data from five nationally representative surveys, the Continuing Survey of Food Intakes by Individuals Surveys (1994-1996) and the What We Eat In America, National Health and Nutrition Examination Surveys (2003-2004, 2005-2006, 2007-2008 and 2009-2010) were used to examine key food sources and energy from solid fats and added sugars. Sample sizes ranged from 2594 to 8259 per survey period, for a total of 17 268 observations across the five surveys. Food files were linked over time to create comparable food groups and nutrient values. Differences were examined by age, race/ethnicity and family income.

RESULTS

Daily intake of energy from SoFAS among U.S. 2-18 year olds decreased from 1994 to 2010, with declines primarily detected in the recent time periods. Solid fats accounted for a greater proportion of total energy intake than did added sugars.

CONCLUSIONS

Although the consumption of solid fats and added sugars among children and adolescents in the U.S. decreased between 1994-1998 and 2009-2010, mean intakes continue to exceed recommended limits.

Evaluation of cardiovascular disease burden and therapeutic goal attainment in US adults with chronic kidney disease: an analysis of national health and nutritional examination survey data, 2001-2010

BACKGROUND

For chronic kidney disease (CKD) patients, national treatment guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal <100 mg/dL and blood pressure (BP) target <130/80 mmHg. This analysis assessed the current status of cardiovascular (CV) risk factor treatment and control in US adults with CKD.

METHODS

Weighted prevalence estimates of CV-related comorbidities, utilization of lipid- and BP-lowering agents, and LDL-C and BP goal attainment in US adults with CKD were assessed among 9,915 men and nonpregnant women aged ≥20 years identified from the fasting subsample of the 2001-2010 National Health and Nutritional Examination Survey (NHANES). Analyses were performed using SAS survey procedures that consider the complex, multistage, probability sampling design of NHANES. All estimates were standardized to the 2008 US adult population (≥20 years). Data were stratified by CKD stage based on presence of albuminuria and estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Stage 3 CKD was subdivided into 3a (eGFR 45-59 mL/min/1.73 m(2)) and 3b (eGFR 30-44 mL/min/1.73 m(2)); Stage 5 CKD and dialysis recipients were excluded.

RESULTS

Of the 9,915 NHANES participants identified for analysis, 1,428 had CKD (Stage 1-4), corresponding to a prevalence estimate for US adults aged ≥20 years of 10.2%. Prevalence of CV-related comorbidities increased markedly with CKD stage, with a ~6-12-fold increase in cardiovascular disease, coronary heart disease (CHD), stroke and congestive heart failure between CKD Stage 1 and 4; prevalence of diabetes, hyperlipidemia and hypertension increased by ~1.2-1.6-fold. Use of lipid-lowering agents increased with CKD stage, from 18.1% (Stage 1) to 44.8% (Stage 4). LDL-C goal attainment increased from 35.8% (Stage 1) to 52.8% (Stage 3b), but decreased in Stage 4 (50.7%). BP goal attainment decreased between Stage 1 and 4 (from 49.5% to 30.2%), despite increased use of antihypertensives (from 30.2% to 78.9%).

CONCLUSIONS

Individuals with CKD have a high prevalence of CV-related comorbidities. However, attainment of LDL-C or BP goals was low regardless of disease stage. These findings highlight the potential for intensive risk factor modification to maximize CV event reduction in CKD patients at high risk for CHD.

Trends in the prevalence of obstructive and restrictive lung function among adults in the United States: findings from the National Health and Nutrition Examination surveys from 1988-1994 to 2007-2010

BACKGROUND

National spirometric surveillance data in the United States were last collected during 1988-1994. The objective of this study was to provide current estimates for obstructive and restrictive impairment of lung function and to examine changes since 1988-1994.

METHODS

We used data from 14,360 participants aged 20 to 79 years from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and 9,024 participants from NHANES 2007-2010. Spirometry was conducted using the same spirometers and generally similar protocols.

RESULTS

During 2007-2010, 13.5% (SE, 0.6) of participants had evidence of airway obstruction (FEV1/FVC < 0.70): 79.9% of adults had normal lung function, 6.5% had a restrictive impairment, 7.5% had mild obstruction, 5.4% had moderate obstruction, and 0.7% had severe obstruction. Although the overall age-adjusted prevalence of any obstruction did not change significantly from 1988-1994 (14.6%) to 2007-2010 (13.5%) (P = .178), significant decreases were noted for participants aged 60 to 79 years and for Mexican Americans. The prevalence of current smoking remained high among participants with moderate (48.4%) and severe (37.9%) obstructive impairments. A significant decline in current smoking occurred only among those with normal lung function (P < .05).

CONCLUSION

Spirometry revealed little change in the prevalence of any obstructive and restrictive impairment in lung function during 2007-2010, compared with 1988-1994.

Height and weight bias: the influence of time

BACKGROUND

We have previously identified in a study of both self-reported body mass index (BMI) and clinically measured BMI that the sensitivity score in the obese category has declined over a 10-year period. It is known that self-reported weight is significantly lower that measured weight and that self-reported height is significantly higher than measured height. The purpose of this study is to establish if self-reported height bias or weight bias, or both, is responsible for the declining sensitivity in the obese category between self-reported and clinically measured BMI.

METHODS

We report on self-reported and clinically measured height and weight from three waves of the Surveys of Lifestyle Attitudes and Nutrition (SLÁN) involving a nationally representative sample of Irish adults. Data were available from 66 men and 142 women in 1998, 147 men and 184 women in 2002 and 909 men and 1128 women in 2007. Respondents were classified into BMI categories normal (<25 kg/m(2)), overweight (25-<30 kg/m(2)) and obese (≥30 kg/m(2)).

RESULTS

Self-reported height bias has remained stable over time regardless of gender, age or clinical BMI category. Self-reported weight bias increases over time for both genders and in all age groups. The increased weight bias is most notable in the obese category.

CONCLUSIONS

BMI underestimation is increasing across time. Knowledge that the widening gap between self-reported BMI and measured BMI is attributable to an increased weight bias brings us one step closer to accurately estimating true obesity levels in the population using self-reported data.

Secular trends in the diagnosis and treatment of obesity among US adults in the primary care setting

Excess weight afflicts the majority of the US adult population. Research suggests that the role of primary care physicians in reducing overweight and obesity is essential; moreover, little is known about self-care of obesity. This report assessed the secular trends in the care of overweight and investigated the secular association between obesity with care of overweight in primary care and self-care of overweight. Cross-sectional evaluation of the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the Continuous NHANES (1999-2008) was employed; the total sample comprised 31,039 nonpregnant adults aged 20-90 years. The relationship between diagnosed overweight, and directed weight loss with time and obesity was assessed. Despite the combined secular increase in the prevalence of overweight and obesity (BMI >25.0 kg/m(2)) between 1994 and 2008 (56.1-69.1%), there was no secular change in the odds of being diagnosed overweight by a physician when adjusted for covariates; however, overweight and obese individuals were 40 and 42% less likely to self-diagnose as overweight, and 34 and 41% less likely to self-direct weight loss in 2008 compared to 1994, respectively. Physicians were also significantly less likely to direct weight loss for overweight and obese adults with weight-related comorbidities across time (P < 0.05). Thus, the surveillance of secular trends reveals that the likelihood of physician- and self-care of overweight decreased between 1994 and 2008 and further highlights the deficiencies in the management of excess weight.

Examining periodontal disease disparities among U.S. adults 20 years of age and older: NHANES III (1988-1994) and NHANES 1999-2004

OBJECTIVE

We examined disparities in periodontal disease in U.S. adults according to age, sex, race/ethnicity, country of birth, education, income, and poverty-income ratio within and between the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and NHANES 1999-2004.

METHODS

We assessed disparities and changes therein using prevalence differences and ratios, as well as the Symmetrized Theil Index (STI). While these measures document disparities between pairs of population subgroups, and changes in relative disparities between surveys, the STI is a summary measure of health disparities that also tracks between-group disparities relative to the total population.

RESULTS

Prevalence differences and ratios for the prevalence of periodontitis, the mean pocket depth (PD), and the mean clinical attachment loss (CAL) suggest that periodontal disease significantly decreased between NHANES III and NHANES 1999-2004 (p<0.01). However, the STI for the prevalence of periodontitis suggests that disparities significantly increased within categories of race/ethnicity, country of birth, and education in NHANES 1999-2004 compared with NHANES III. These findings were corroborated for mean PD and mean CAL (p<0.001): the overall STI significantly increased for mean PD from 4.53% in NHANES III to 11.02% in NHANES 1999-2004 and for mean CAL for teeth with CAL >0 from 31.73% in NHANES III to 43.36% in NHANES 1999-2004.

CONCLUSIONS

Our findings suggest that inequalities in periodontal disease significantly decreased between NHANES III and NHANES 1999-2004 in the total population and across selected characteristics of the population. However, these inequalities increased within groups of the population in NHANES 1999-2004 compared with NHANES III. These findings call attention to the absolute and relative differences not only between population groups across surveys, but also within population groups within and between surveys.

Trends in cardiovascular risk factor levels in the Minnesota Heart Survey (1980-2002) as compared with the National Health and Nutrition Examination Survey (1976-2002): A partial explanation for Minnesota's low cardiovascular disease mortality?

The authors compared trends in and levels of coronary heart disease (CHD) risk factors between the Minneapolis-St. Paul, Minnesota, metropolitan area (Twin Cities) and the entire US population to help explain the ongoing decline in US CHD mortality rates. The study populations for risk factors were adults aged 25-74 years enrolled in 2 population-based surveillance studies: the Minnesota Heart Survey (MHS) in 1980-1982, 1985-1987, 1990-1992, 1995-1997, and 2000-2002 and the National Health and Nutrition Examination Survey (NHANES) in 1976-1980, 1988-1994, 1999-2000, and 2001-2002. The authors found a continuous decline in CHD mortality rates in the Twin Cities and nationally between 1980 and 2000. Similar decreasing rates of change in risk factors across survey years, parallel to the CHD mortality rate decline, were observed in MHS and in NHANES. Adults in MHS had generally lower levels of CHD risk factors than NHANES adults, consistent with the CHD mortality rate difference. Approximately 47% of women and 44% of men in MHS had no elevated CHD risk factors, including smoking, hypertension, high cholesterol, and obesity, versus 36% of women and 34% of men in NHANES. The better CHD risk factor profile in the Twin Cities may partly explain the lower CHD death rate there.