Multiple health behaviors and serum hepatic enzymes among US adults with obesity

INTRODUCTION

This study was to examine the cumulative number and clustering patterns of low-risk health behaviors (i.e., not currently smoking, not excessive drinking, and physically active) associated with elevation of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among adults with obesity in the United States.

METHODS

We estimated the age-adjusted prevalence of elevated ALT, AST, and GGT from 4547 adults with obesity aged ≥ 20 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. The associations between the cumulative number or clustering patterns of low-risk health behaviors and measures of serum ALT, AST, and GGT were assessed using multivariate regression models.

RESULTS

Adult men who reported having three low-risk health behaviors were 62%, 39%, and 48% less likely to have elevated serum ALT, AST, and GGT, respectively; adult women were 56% and 73% less likely to have elevated serum AST and GGT, respectively, when compared to their respective counterparts who reported having none of the low-risk health behaviors.

CONCLUSIONS

The findings of this study indicate that, among adults with obesity, having multiple low-risk health behaviors is associated with decreased likelihoods of elevated hepatic enzymes, including ALT in men, AST and GGT in both men and women.

Use of folic acid and vitamin supplementation among adults with depression and anxiety: a cross-sectional, population-based survey

Background

Evidence suggests that folate deficiency may be causatively linked to depressive symptoms. However, little is known on the status of use of folic acid and vitamin supplements among people with mental disorders. This study examined the prevalence and the likelihood of use of folic acid or vitamin supplements among adults with depression and anxiety in comparison to those without these conditions.

Methods

Using data from 46, 119 participants (aged ≥ 18 years) in the 2006 Behavioral Risk Factor Surveillance System survey, we estimated the adjusted prevalence and odds ratios with 95% confidence intervals for taking folic acid and vitamin supplements among those with ever diagnosed depression (n = 8, 019), ever diagnosed anxiety (n = 5, 546) or elevated depressive symptoms (n = 3, 978, defined as having a depression severity score of ≥ 10 on the Patient Health Questionnaire-8 diagnostic algorithm).

Results

Overall, women were more likely than men to take folic acid supplements 1-4 times/day (50.2% versus 38.7%, P < 0.001) and vitamin supplements (62.5% versus 49.8%, P < 0.001). After multivariate adjustment, men with ever diagnosed depression or anxiety were 42% and 83%, respectively, more likely to take folic acid supplements < 1 time/day; 44% and 39%, respectively, more likely to take folic acid supplements 1-4 times/day; and 40% and 46%, respectively, more likely to take vitamin supplements compared to men without these conditions (P < 0.05 for all comparisons). Women with ever diagnosed depression were 13% more likely to take folic acid supplements 1-4 times/day and 15% more likely to take vitamin supplements than women without this condition (P < 0.05 for both comparisons). Use of folic acid and vitamin supplements did not differ significantly by elevated depressive symptoms in either sex.

Conclusion

The prevalence and the likelihood of taking folic acid and vitamin supplements varied substantially by a history of diagnosed depression among both men and women and by a history of diagnosed anxiety among men, but not by presence of elevated depressive symptoms in either sex.

Adverse childhood experiences and smoking status in five states

OBJECTIVE

Our objective was to examine the associations between adverse childhood experiences (ACEs) and smoking behavior among a random sample of adults living in five U.S. states.

METHODS

We used data from 25,809 participants of the 2009 Behavioral Risk Factor Surveillance System to assess the relationship of each of the 8 adverse childhood experiences and the adverse childhood experience score to smoking status.

RESULTS AND CONCLUSIONS

Some 59.4% of men and women reported at least one adverse childhood experience. Each of the eight adverse childhood experiences measures was significantly associated with smoking status after adjustment for demographic variables. The prevalence ratios for current and ever smoking increased in a positive graded fashion as the adverse childhood experience score increased. Among adults who reported no adverse childhood experiences, 13.0% were currently smoking and 38.3% had ever smoked. Compared to participants with an adverse childhood experience score of 0, those with an adverse childhood experience score of 5 or more were more likely to be a current smoker (adjusted prevalence ratio (aPR): 2.22, 95% confidence interval [CI]: 1.92-2.57) and to have ever smoked (aPR: 1.80, 95% CI: 1.67-1.93). Further research is warranted to determine whether the prevention of and interventions for adverse childhood experiences might reduce the burden of smoking-related illness in the general population.

Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study

OBJECTIVES

We examined the relationship between 4 low-risk behaviors-never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption-and mortality in a representative sample of people in the United States.

METHODS

We used data from 16958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006.

RESULTS

The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio [AHR]=0.37; 95% confidence interval [CI]=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high-risk behaviors compared with those who had none were 11.1 years for all-cause mortality, 14.4 years for malignant neoplasms, 9.9 years for major cardiovascular disease, and 10.6 years for other causes.

CONCLUSIONS

Low-risk lifestyle factors exert a powerful and beneficial effect on mortality.

Uric acid and mortality from all-causes and cardiovascular disease among adults with and without diagnosed diabetes: findings from the National Health and Nutrition Examination Survey III Linked Mortality Study

Using data from the National Health and Nutrition Examination Survey III Linked Mortality Study, uric acid concentration was significantly related to mortality from all-causes (978 diabetic participants: hazard ratio per mg/dl, 1.14; 95% confidence interval, 1.01-1.28; 12,824 nondiabetic participants: hazard ratio, 1.06; 95% confidence interval, 1.02-1.11) but not major CVD.

Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care

Mortality rates from coronary heart disease (CHD), which had risen during the twentieth century in many countries, started declining in some countries during the 1960s. Once initial skepticism about the validity of the observed trends dissipated, researchers attempted to generate explanations about the events that had transpired using a variety of techniques, including ecological examinations of the trends in risk factors for CHD and changes in management of CHD, multivariate risk equations, and increasingly sophisticated modeling techniques. Improvements in risk factors as well as changes in cardiac treatments have both contributed to the reductions in CHD mortality, although estimates of their contributions have varied among countries. Models suggest that additional large reductions in CHD mortality are feasible by either improving the distribution of risk factors in the population or raising the percentage of patients receiving evidence-based treatments.

Trends in mortality from all causes and cardiovascular disease among hypertensive and nonhypertensive adults in the United States

BACKGROUND

Little is known about trends in the mortality rate among people with hypertension in the United States. The objective of the present study was to examine the change in the all-cause mortality rate among people with and without hypertension in the United States and whether any such changes differed by sex or race.

METHODS AND RESULTS

Data from 10 852 participants aged 25 to 74 years of the National Health and Nutrition Examination Survey (NHANES) I Epidemiological Follow-Up Study (1971 to 1975) and of 12 420 participants of the NHANES III Linked Mortality Study (1988 to 1994) were used. The mean follow-up times were 17.5 and 14.2 years, respectively. In each cohort, the mortality rate was higher among hypertensive adults than nonhypertensive adults, among hypertensive men than hypertensive women, and among hypertensive blacks than hypertensive whites. Among all hypertensive participants, the age-adjusted mortality rate was 18.8 per 1000 person-years for NHANES I and 14.3 for NHANES III (13.3 and 9.1 per 1000 person-years for nonhypertensive participants, respectively). The reduction among hypertensive men (7.7 per 1000 person-years; 95 confidence interval, 5.2 to 10.2) exceeded that among hypertensive women (1.9 per 1000 person-years; 95 confidence interval, [-0.4 to 4.2]) (P<0.001), and the reduction among hypertensive blacks (5.4 per 1000 person-years; 95 confidence interval, [0.6 to 10.1]) exceeded that among hypertensive whites (4.4 per 1000 person-years; 95 confidence interval, [2.2 to 6.5]) (P=0.707).

CONCLUSIONS

The mortality rate decreased among hypertensive adults, but the mortality gap between adults with and without hypertension remained relatively constant. Efforts are needed to accelerate the decrease in the mortality rate among hypertensive adults.

Changes in mortality among US adults with COPD in two national cohorts recruited from 1971-1975 and 1988-1994

BACKGROUND

COPD is a major contributor to the global burden of disease. Our objective was to examine changes in the mortality rate among persons with COPD in the United States.

METHODS

We conducted prospective studies using data from 5,185 participants in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (baseline examination from 1971-1975; follow-up from 1992-1993) and 10,954 participants of the NHANES III Linked Mortality Study (baseline examination from 1988-1994; follow-up through 2006).

RESULTS

The age-adjusted rate (per 1,000 person-years) among participants with moderate or severe COPD (23.9 and 20.2) was about 2.5 to 3 times higher than the rate among participants with normal lung function (10.4 and 6.2) in NHANES I and NHANES III, respectively. Compared with NHANES I, the mortality rate among participants in NHANES III decreased by 15.8% for those with moderate or severe COPD, 25.2% for those with mild COPD, 35.9% for those with respiratory symptoms with normal lung function, 16.6% for those with restrictive impairment, and 40.1% for those with normal lung function. However, the decrease did not reach statistical significance among participants with moderate or severe COPD. The decreases in the mortality rate among men with moderate or severe COPD (-17.8%) or with restrictive impairment (-35.1%) exceeded the changes among women (+3% and -6.1%, respectively).

CONCLUSIONS

The secular decline in the mortality rate in the United States benefited people with COPD less than those with normal lung function.

Association between diagnosed diabetes and self-reported cancer among U.S. adults: findings from the 2009 Behavioral Risk Factor Surveillance System

OBJECTIVE

To assess the association between diagnosed diabetes and self-reported cancer among U.S. adults.

RESEARCH DESIGN AND METHODS

We analyzed data for 397,783 adults who participated in the 2009 Behavioral Risk Factor Surveillance System and had valid data on diabetes and cancer.

RESULTS

After adjustment for potential confounders, diabetic men had higher adjusted prevalence ratios for cancers of the prostate (1.1 [95% CI 1.0-1.3]), colon (1.3 [1.0-1.7]), pancreas (4.6 [1.8-11.7]), rectum (2.2 [1.0-4.7]), urinary bladder (1.7 [1.2-2.2]), and kidney (1.9 [1.2-3.0]) than nondiabetic men (all P < 0.05). Diabetic women had higher adjusted prevalence ratios for cancers of the breast (1.1 [1.0-1.3]) and endometrium (1.6 [1.2-2.0]), and leukemia (2.3 [1.3-4.2]) than nondiabetic women (all P < 0.05).

CONCLUSIONS

Our results suggest that diabetic adults have higher prevalences of certain cancers than nondiabetic adults.

Trends in the risk for coronary heart disease among adults with diagnosed diabetes in the U.S.: findings from the National Health and Nutrition Examination Survey, 1999-2008

OBJECTIVE

Coronary heart disease (CHD) is a major cause of mortality among people with diabetes. The objective of this study was to examine the trend in an estimated 10-year risk for developing CHD among adults with diagnosed diabetes in the U.S.

RESEARCH DESIGN AND METHODS

Data from 1,977 adults, aged 30-79 years, with diagnosed diabetes who participated in the National Health and Nutrition Examination Survey from 1999-2000 to 2007-2008 were used. Estimated risk was calculated using risk prediction algorithms from the UK Prospective Diabetes Study (UKPDS), the Atherosclerosis Risk in Communities study, and the Framingham Heart Study.

RESULTS

Significant improvements in mean HbA(1c) concentrations, systolic blood pressure, and the ratio of total cholesterol to HDL cholesterol occurred. No significant linear trend for current smoking status was observed. The estimated UKPDS 10-year risk for CHD was 21.1% in 1999-2000 and 16.4% in 2007-2008 (P(linear trend) < 0.001). The risk decreased significantly among men, women, whites, African Americans, and Mexican Americans.

CONCLUSIONS

The estimated 10-year risk for CHD among adults with diabetes has improved significantly from 1999-2000 to 2007-2008. Sustained efforts in improving risk factors should further benefit the cardiovascular health of people with diabetes.

Co-occurrence of obesity and patterns of alcohol use associated with elevated serum hepatic enzymes in US adults

The aim of this cross-sectional study was to present nationally representative findings on the co-occurrence of obesity and specific patterns of alcohol use associated with elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among adults in the United States. We analyzed data from 8,373 adults aged ≥ 20 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. We produced prevalence ratios by using the co-occurrence of obesity (i.e., body mass index ≥ 30.0 kg/m(2) or waist circumference ≥ 102 cm in men and ≥ 88 cm in women) and specific patterns of alcohol use (i.e., non-drinkers, non-excessive drinkers, and excessive drinkers) as a predictor; elevations in serum ALT, AST, and GGT were used as an outcome variable while adjusting for covariates in multivariate regression models. Approximately 34.7% of adult men and 38.6% of adult women in the United States had co-occurrence of obesity and any alcohol use, including 16.4% of men and 9.8% of women who had co-occurrence of obesity and excessive drinking during 2005-2008. When compared to male non-drinkers without obesity after multivariate adjustment, male excessive drinkers with obesity were 3.08 (95% CI: 1.80-5.28), 2.42 (95% CI: 1.80-3.26), and 3.15 (95% CI: 1.82-5.46) times more likely to exhibit elevated serum ALT, AST, and GGT, respectively. Similarly, when compared to female non-drinkers without obesity, female excessive drinkers with obesity were 2.36 (95% CI: 1.38-4.04), 3.27 (95% CI: 1.85-5.78), and 3.43 (95% CI: 2.19-5.40) times more likely to have elevated serum ALT, AST, and GGT, respectively. The co-occurrence of obesity and excessive drinking may place adults at an increased risk for potential liver injury. Our study findings provide support for evidence-based clinical and population-based interventions that integrate health behavior change among adults who have these co-occurring risk factors.

Serum non-high-density lipoprotein cholesterol concentration and risk of death from cardiovascular diseases among U.S. adults with diagnosed diabetes: the Third National Health and Nutrition Examination Survey linked mortality study

Background

Non-high-density lipoprotein cholesterol (non-HDL-C) measures all atherogenic apolipoprotein B-containing lipoproteins and predicts risk of cardiovascular diseases (CVD). The association of non-HDL-C with risk of death from CVD in diabetes is not well understood. This study assessed the hypothesis that, among adults with diabetes, non-HDL-C may be related to the risk of death from CVD.

Methods

We analyzed data from 1,122 adults aged 20 years and older with diagnosed diabetes who participated in the Third National Health and Nutrition Examination Survey linked mortality study (299 deaths from CVD according to underlying cause of death; median follow-up length, 12.4 years).

Results

Compared to participants with serum non-HDL-C concentrations of 35 to 129 mg/dL, those with higher serum levels had a higher risk of death from total CVD: the RRs were 1.34 (95% CI: 0.75-2.39) and 2.25 (95% CI: 1.30-3.91) for non-HDL-C concentrations of 130-189 mg/dL and 190-403 mg/dL, respectively (P = 0.003 for linear trend) after adjustment for demographic characteristics and selected risk factors. In subgroup analyses, significant linear trends were identified for the risk of death from ischemic heart disease: the RRs were 1.59 (95% CI: 0.76-3.32) and 2.50 (95% CI: 1.28-4.89) (P = 0.006 for linear trend), and stroke: the RRs were 3.37 (95% CI: 0.95-11.90) and 5.81 (95% CI: 1.96-17.25) (P = 0.001 for linear trend).

Conclusions

In diabetics, higher serum non-HDL-C concentrations were significantly associated with increased risk of death from CVD. Our prospective data support the notion that reducing serum non-HDL-C concentrations may be beneficial in the prevention of excess death from CVD among affected adults.

Iron-deficiency anemia, non-iron-deficiency anemia and HbA1c among adults in the US

BACKGROUND

Conditions that affect erythrocyte turnover affect HbA1c concentrations. Although many forms of anemia are associated with lowering of HbA1c, iron deficiency tends to increase HbA1c. We examined the effect of iron and hemoglobin (Hb) status on HbA1c and on the relationship between concentrations of fasting glucose and HbA1c in a national sample of adults in the US.

METHODS

Cross-sectional data from 8296 adults aged ≥ 20 years who participated in NHANES 1999-2002 were used.

RESULTS

The prevalence of low Hb (defined as <120 and < 118 g/L in women aged 20-69 and ≥ 70 years, respectively, and <137, <133, and < 124 g/L in men aged 20-49, 50-69, and ≥ 70 years, respectively) was 5.5%. There was a significant positive correlation between Hb concentrations and HbA1c concentrations after adjusting for age, gender, and race or ethnicity, with HbA1c rising from a mean of 5.28% among participants with Hb < 100 g/L to 5.72% among participants with Hb ≥ 170 g/L. The adjusted mean concentrations of HbA1c were 5.56% and 5.46% among participants with and without iron deficiency, respectively (P = 0.095). However, there was no evidence of differences in the relationship between fasting glucose and HbA1c when groups of anemic and non-anemic individuals with and without iron deficiency were examined individually.

CONCLUSIONS

Caution should be used when diagnosing diabetes and prediabetes among people with high or low Hb when the HbA1c level is near 6.5% or 5.7%, respectively, as changes in erythrocyte turnover may alter the test result. However, the trend for HbA1c to increase with iron deficiency does not appear to require screening for iron deficiency in ascertaining the reliability of HbA1c in the diagnosis of diabetes and prediabetes in a given individual.

Associations between concentrations of vitamin D and concentrations of insulin, glucose, and HbA1c among adolescents in the United States

OBJECTIVE

Our objective was to examine the associations between concentrations of vitamin D and concentrations of insulin, glucose, and HbA(1c) in a nationally representative sample of adolescents in the U.S.

RESEARCH DESIGN AND METHODS

We used data for 1,941 adolescents, aged 12-17 years, who participated in the National Health and Nutrition Examination Survey between 2001 and 2006.

RESULTS

Adjusted concentrations of insulin were ~24% lower among male subjects with a concentration of vitamin D ≥ 75 nmol/L than among male subjects with a concentration of vitamin D <50 nmol/L (P = 0.003). Concentrations of vitamin D were inversely associated with concentrations of glucose only among Mexican American male subjects (P = 0.007). No significant associations between concentrations of vitamin D and HbA(1c) were detected.

CONCLUSIONS

Our results support an inverse association between concentrations of vitamin D and insulin primarily in adolescent male subjects.

Non-high-density lipoprotein cholesterol concentration is associated with the metabolic syndrome among US youth aged 12-19 years

OBJECTIVE

To test the hypothesis that the concentration of non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the metabolic syndrome (MetS) in youth.

STUDY DESIGN

Data on children and adolescents aged 12-19 years (n = 2734) from the cross-sectional National Health and Nutrition Examination Survey 1999-2004 were analyzed.

RESULTS

Depending on the definition of MetS used, the mean non-HDL-C concentration among youth with MetS ranged from 144.2 to 155.8 mg/dL, compared with 108.8-109.1 mg/dL in those without MetS (all P < .001). The MetS prevalence ranged from 6.9% to 11.7% in youth with a non-HDL-C concentration of 120-144 mg/dL and from 21.5% to 23.4% in those with a concentration ≥ 145 mg/dL-both significantly higher than the prevalence of 1.9%-3.4% in youth with a concentration <120 mg/dL (all P < .001). After adjustment for potential confounders, youth with a non-HDL-C concentration ≥ 120 mg/dL or ≥ 145 mg/dL were about 3 or 4 times more likely to have MetS compared with those with a non-HDL-C <120 mg/dL or <145 mg/dL (all P < .001).

CONCLUSIONS

Fasting non-HDL-C concentration was strongly associated with MetS in US youth. Our results support the use of non-HDL-C thresholds of 120 mg/dL and 145 mg/dL to indicate borderline and high MetS risk, respectively.

Heart disease and stroke statistics--2011 update: a report from the American Heart Association

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited more than 8700 times in the literature (including citations of all annual versions). In 2009 alone, the various Statistical Updates were cited ≈1600 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas. For this year’s edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year and added a new chapter detailing how family history and genetics play a role in cardiovascular disease (CVD) risk. Also, the 2011 Statistical Update is a major source for monitoring both cardiovascular health and disease in the population, with a focus on progress toward achievement of the AHA’s 2020 Impact Goals. Below are a few highlights from this year’s Update.

Vitamin D and all-cause mortality among adults in USA: findings from the National Health and Nutrition Examination Survey Linked Mortality Study

BACKGROUND

Whether concentrations of vitamin D are related to mortality remains unresolved. Our objective was to examine the relationship between serum concentrations of 25-hydroxyvitamin D and all-cause mortality in a national sample of US adults.

METHODS

We used data from the National Health and Nutrition Examination Survey Mortality Study from 2001 to 2004 with mortality compiled through 2006. Mortality status was established through a match to the National Death Index.

RESULTS

Of the 7531 participants, 347 died. Median follow-up was 3.8 years. The mean unadjusted concentrations of vitamin D were 54.1 nmol/l (21.7 ng/ml) among participants who died and 60.7 nmol/l (24.3 ng/ml) among participants who survived (P = 0.002). After adjustment for socio-demographic factors, the hazard ratios (HR) for all-cause mortality were 1.65 [95% confidence interval (CI): 95% CI: 1.13-2.40] for participants with a concentration <50 nmol/l (<20 ng/ml) and 1.02 (95% CI: 0.74-1.41) for participants with a concentration of 50 to <75 nmol/l (20 to <30 ng/ml) compared with participants who had a concentration of ≥ 75 nmol/l (≥ 30 ng/ml). After more extensive adjustment, the HRs were 1.28 (95% CI: 0.86-1.90) and 0.91 (95% CI: 0.63-1.33), respectively. The fully adjusted HR per 10 nmol/l of vitamin D was 0.93 (95% CI: 0.86-1.01). The HRs did not vary by gender (P = 0.80) or among the three major racial or ethnic groups (P = 0.46).

CONCLUSIONS

Concentrations of vitamin D were weakly and inversely related to all-cause mortality in this sample of US adults.

Prevalence and clustering of metabolic risk factors for type 2 diabetes among Chinese adults in Shanghai, China

Background

Type 2 diabetes is becoming an epidemic in China. To evaluate the prevalence, clustering of metabolic risk factors and their impact on type 2 diabetes, we conducted a population-based study in Shanghai, China's largest metropolitan area.

Methods

From 2006 to 2007, 2,113 type 2 diabetes cases and 2,458 comparable controls of adults aged 40 to 79 years were enrolled. Demographic, lifestyle, and dietary factors were assessed via standardized questionnaires. Plasma, red and white blood cells were collected and stored for future studies. Anthropometric indices and biochemical intermediates (including blood pressure, fasting glucose, glycosylated hemoglobin, and blood lipids) were measured. The prevalence of metabolic syndrome were also compared following two criteria recommended by the Chinese Diabetes Society (CDS, 2004) and the National Cholesterol Education Program's Adult Treatment Panel III (ATP III, 2002).

Results

Prevalence of metabolic syndrome (62% vs. 15% using CDS criteria) and its individual components, including obesity (51% vs. 42%), hypertension (54% vs. 41%), hypertriglyceridemia (42% vs. 32%), and low high-density lipoprotein-cholesterol (HDL) levels (36% vs. 25%) were higher in diabetes cases than controls. Regardless of criteria used, those with impaired fasting glucose (IFG) had similarly high prevalence of metabolic syndrome as did diabetes cases. In a multiple logistic regression model adjusted for demographics and lifestyle risk factors, the odds ratios of diabetes (95% CI) were 1.23 (1.04-1.45) for overweight (28 >= BMI >= 24), 1.81 (1.45-2.25) for obesity (BMI > 28), 1.53 (1.30-1.80) for central obesity (waist circumference > 80 cm for woman or waist circumference > 85 cm for man), 1.36 (1.17-1.59) for hypertension (sbp/dbp >= 140/90 mmHg), 1.55 (1.32-1.82) for high triglycerides (triglycerides > 1.70 mmol/l) and 1.52 (1.23-1.79) for low HDL-C (HDL-C < 1.04 mmol/L).

Conclusions

These data indicate that multiple metabolic risk factors--individually or jointly--were more prevalent in diabetes patients than in controls. Further research will examine hypotheses concerning the high prevalence of IFG, family history, and central obesity, aiding development of multifaceted preventive strategies specific to this population.

Trends in low-risk lifestyle factors among adults in the United States: findings from the Behavioral Risk Factor Surveillance System 1996-2007

OBJECTIVE

Our objective was to examine recent trends in low-risk lifestyle factors for chronic diseases (not currently smoking, any exercise during the past 30 days, consuming fruits and vegetables ≥5 times per day, and body mass index <25kg/m(2)) among U.S. adults.

METHODS

We used data from 1,580,220 adults aged ≥18 years who participated in one of seven Behavioral Risk Factor Surveillance System surveys conducted from 1996 to 2007.

RESULTS

The age-adjusted percentage of adults meeting all four low-risk lifestyle factors was 8.5% in 1996 and 7.7% in 2007 (p for linear trend <0.001). Significant decreasing trends were noted for men, women, whites, Hispanics, and most age groups. The percentages of participants who were not currently smoking, who had done any exercise during the past 30 days, who reported consuming fruits and vegetables ≥5 times per day, and who had a body mass index <25kg/m(2) were 70.9%, 76.2%, 47.9% and 24.3%, respectively, in 1996 and 77.1%, 80.0%, 37.8%, and 24.5%, respectively, in 2007. Women and whites were more likely than their counterparts to meet all four criteria.

CONCLUSIONS

From 1996 to 2007, the percentage of U.S. adults meeting all four low-risk lifestyle factors decreased slightly.

Sedentary behavior, physical activity, and concentrations of insulin among US adults

Time spent watching television has been linked to obesity, metabolic syndrome, and diabetes, all conditions characterized to some degree by hyperinsulinemia and insulin resistance. However, limited evidence relates screen time (watching television or using a computer) directly to concentrations of insulin. We examined the cross-sectional associations between time spent watching television or using a computer, physical activity, and serum concentrations of insulin using data from 2800 participants aged at least 20 years of the 2003-2006 National Health and Nutrition Examination Survey. The amount of time spent watching television and using a computer as well as physical activity was self-reported. The unadjusted geometric mean concentration of insulin increased from 6.2 microU/mL among participants who did not watch television to 10.0 microU/mL among those who watched television for 5 or more hours per day (P = .001). After adjustment for age, sex, race or ethnicity, educational status, concentration of cotinine, alcohol intake, physical activity, waist circumference, and body mass index using multiple linear regression analysis, the log-transformed concentrations of insulin were significantly and positively associated with time spent watching television (P = < .001). Reported time spent using a computer was significantly associated with log-transformed concentrations of insulin before but not after accounting for waist circumference and body mass index. Leisure-time physical activity but not transportation or household physical activity was significantly and inversely associated with log-transformed concentrations of insulin. Sedentary behavior, particularly the amount of time spent watching television, may be an important modifiable determinant of concentrations of insulin.

Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US

BACKGROUND

Recently, a Joint Scientific Statement bridged differences between previous definitions of metabolic syndrome. Our objective was to estimate the prevalence of metabolic syndrome in a representative sample of US adults and to examine its correlates.

METHODS

We analyzed data for up to 3461 participants aged ≥ 20 years of the 2003-2006 National Health and Nutrition Examination Survey.

RESULTS

Using waist circumference thresholds of ≥ 102 cm for men and ≥ 88 cm for women, the age-adjusted prevalence of metabolic syndrome was 34.3% among all adults, 36.1% among men, and 32.4% among women. Using racial- or ethnic-specific International Diabetes Federation criteria for waist circumference, the age-adjusted prevalence of metabolic syndrome was 38.5% for all participants, 41.9% for men, and 35.0% for women. Prevalence increased with age, peaking among those aged 60-69 years. Prevalence was lower among African American men than White or Mexican American men, and lower among White women than among African American or Mexican American women. In a multivariate regression model, significant independent associations were noted for age (positive), gender (men higher than women), race or ethnicity (African Americans and participants of another race lower than Whites), educational status (inverse), hypercholesterolemia (positive), concentrations of C-reactive protein (positive), leisure time physical activity (inverse), microalbuminuria (positive), and hyperinsulinemia (positive). Additional adjustment for body mass index weakened many of the associations, with educational status and microalbuminuria no longer significant contributors to the model.

CONCLUSION

Metabolic syndrome continues to be highly prevalent among adults in the US.

Coronary mortality declines in the U.S. between 1980 and 2000 quantifying the contributions from primary and secondary prevention

BACKGROUND

Coronary heart disease (CHD) mortality rates in the U.S. have halved since 1980. However, CHD remains a leading cause of death. The relative importance of secondary and primary prevention in explaining falls in coronary heart disease mortality is debated.

PURPOSE

The aim of this study was to quantify the primary and secondary preventive contributions to the U.S. CHD mortality fall between 1980 and 2000.

METHODS

The IMPACT model was used to estimate contributions to the U.S. CHD mortality fall from risk factor declines in asymptomatic individuals (primary prevention) and in CHD patients (secondary prevention). Analyses were carried out in 2008.

RESULTS

Approximately 316,100 fewer deaths were attributable to risk factor declines: 64,930 in CHD patients (21%) and 251,170 in asymptomatic individuals (79%). Smoking declines accounted for approximately 8390 fewer deaths in CHD patients and for 46,315 fewer deaths in asymptomatic people. Cholesterol falls gave approximately 22,210 fewer deaths in CHD patients and 107,300 fewer deaths in asymptomatic people. Statins accounted for approximately 16,580 fewer deaths, that is, one sixth of this mortality fall. Systolic blood pressure declines accounted for approximately 34,330 fewer deaths among CHD patients and 97,555 fewer deaths in asymptomatic individuals. Antihypertensive medications accounted for approximately 23,845 fewer deaths.

CONCLUSIONS

Half of the U.S. mortality fall in coronary heart disease between 1980 and 2000 was attributable to risk factor declines, with primary prevention producing substantially larger mortality reductions than secondary.

An Analysis of Language as a Barrier to Receiving Influenza Vaccinations among an Elderly Hispanic Population in the United States

Background. The Hispanic population in the United States is growing, and disparities in the receipt of healthcare services as a result of limited English proficiency have been demonstrated. We set out to determine if Spanish language preference was a barrier to receiving influenza vaccinations among Hispanic persons 65 years and older in the USA. Methods. Differences in the receipt of vaccinations by language preference were tested with both Chi-square analyses and adjusted logistic regression analyses. Results. Findings suggest that elderly Hispanic persons, 65 years of age and older, who prefer to communicate in Spanish instead of English, are significantly less likely to have received influenza vaccinations when compared to their Hispanic counterparts who prefer to communicate in English. Conclusions. Influenza infections can more often be fatal in older persons and may disparately affect minority populations such as Hispanic persons. Therefore, understanding barriers to the receipt of effective preventive health measures is necessary.