Dietary intake of vitamins, minerals, and fiber of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91

Intervention strategies aimed at reducing the prevalence of nutrition-related diseases, including designing nutrition policies and nutrition education and assistance programs, require effective monitoring of what Americans are eating. Nutrient reference data from the third National Health and Nutrition Examination Survey provide essential information to achieve these goals. Mean and median iron intakes were adequate in males of all race-ethnic groups but were generally low in females and young children. Mean and median calcium intakes were also higher in males than in females and were lower than recommendations in adolescents and in women of all ages. Mean sodium intakes for all age, sex, and race-ethnic groups exceeded the minimum requirements of healthy persons and were higher in non-Hispanic black children and adolescents than in non-Hispanic white and Mexican American children and adolescents. Mean fiber intakes also did not meet recommendations in most subgroups and were higher in Mexican American adults followed by non-Hispanic white adults and non-Hispanic black adults. Further research is planned to compare the food sources of energy and nutrients consumed by different population groups in NHANES III to similar results from earlier nation surveys. NHANES III, Phase 2 (1991-94) recalls were collected using the same dietary method as those collected in Phase 1 (1988-91), and other analyses will compare findings from both phases of NHANES III.

Trauma in the elderly: an analysis of outcomes based on age

This study evaluated the comparative outcomes of elderly trauma patients admitted to a tertiary Surgical Intensive Care Unit (SICU) over a 5-year period (4/1/87-3/31/92). A total of 289 trauma patients 65 or older (mean age 76.3 +/- 0.4 years) were compared with 1,877 trauma patients under age 65 (mean age 31.4 +/- 0.3). The Simplified Acute Physiology Score (SAPS) severity of illness on admission for elderly trauma patients was 12.2 +/- 0.3, significantly higher than the SAPS of the younger patient group, 7.9 +/- 0.1 (P < 0.0005). Elderly survivors had higher than the SAPS of admission than their younger cohorts, 11.0 +/- 0.3 versus 7.3 +/- 0.1 (P < 0.0005), but there was no significant difference in SAPS for non-survivors. The Injury Severity Score (ISS) of elderly patients, 14.2 +/- 1.0, was not significantly higher than the ISS of younger patients, 12.3 +/- 0.3 (P = 0.06). Thirty-three elderly trauma patients (11.4%) died in the SICU, compared with 90 (4.8%) deaths in younger patients (P < 0.00005). However, when patients were stratified by admission SAPS, SICU mortality was nearly equivalent between the older and younger patient groups. An additional 14 elderly patients (4.8%) died in the hospital after SICU discharge, compared with 9 additional deaths (0.5%) in the younger patient group (P < 0.00005).(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of apolipoproteins A-I and B during the National Health and Nutrition Examination Survey (NHANES) III

We measured apolipoproteins (apo) A-I and B by rate immunonephelometry (rate INA) during Phase 1 of the National Health and Nutrition Examination Survey (NHANES) III. We also made the measurements by radial immunodiffusion (RID) in a 20% subset of the samples. Aliquots of this subset were also analyzed in the Northwest Lipid Research Laboratories by fixed-time INA calibrated to the World Health Organization (WHO)-International Federation of Clinical Chemistry (IFCC) First International Reference Materials for Apolipoproteins A-I and B. The CVs for the rate INA and RID measurements were: apoA-I, 4.5-7.7% and 2.5-7.6%, respectively; apoB, 2.3-5.3% and 2.3-6.4%, respectively. In NHANES III, rate INA values (x) can be transformed to WHO-IFCC Reference Material-based values (y) as follows: for apoA-I, y = 0.87x + 251.8 mg/L (r = 0.93, SEslope = 0.13, SEintercept = 17, n = 708); for apoB (mg/L), y = 1.068x + 112.8 mg/L (r = 0.98, SEslope = 0.08, SEintercept = 7, n = 646).

Measurement of apolipoproteins A-I and B during the National Health and Nutrition Examination Survey (NHANES) III

We measured apolipoproteins (apo) A-I and B by rate immunonephelometry (rate INA) during Phase 1 of the National Health and Nutrition Examination Survey (NHANES) III. We also made the measurements by radial immunodiffusion (RID) in a 20% subset of the samples. Aliquots of this subset were also analyzed in the Northwest Lipid Research Laboratories by fixed-time INA calibrated to the World Health Organization (WHO)-International Federation of Clinical Chemistry (IFCC) First International Reference Materials for Apolipoproteins A-I and B. The CVs for the rate INA and RID measurements were: apoA-I, 4.5-7.7% and 2.5-7.6%, respectively; apoB, 2.3-5.3% and 2.3-6.4%, respectively. In NHANES III, rate INA values (x) can be transformed to WHO-IFCC Reference Material-based values (y) as follows: for apoA-I, y = 0.87x + 251.8 mg/L (r = 0.93, SEslope = 0.13, SEintercept = 17, n = 708); for apoB (mg/L), y = 1.068x + 112.8 mg/L (r = 0.98, SEslope = 0.08, SEintercept = 7, n = 646).

Field evaluation of the NOVA Celltrak 12 hematology analyzer

An evaluation of the NOVA Celltrak 12 was performed over a 6-week period. Precision, linearity, carryover, and reproducibility of values compared favorably to manufacturers' claims. The correlation was performed using the Coulter S Plus VI as the reference instrument and yielded coefficients of correlation for measured parameters of greater than .98 with the exception of RDW at r = .84, MCV at r = 0.96, and MPV at r = .92. Three-part differential information and an expanded flagging system affords increased clinical information and trouble-shooting guides. The three-part differential information compared favorably with that of the Coulter S Plus VI with lymphocyte percentage r = .96, granulocyte percentage r = .94, and monocyte percentage r = .50. We conclude that this instrument performed well in a clinical setting.

Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991

OBJECTIVE

To examine trends in overweight prevalence and body mass index of the US adult population.

DESIGN

Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.

SETTING/PARTICIPANTS

Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANES II), and 1988 to 1991 (NHANES III phase 1).

RESULTS

In the period 1988 to 1991, 33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.

CONCLUSIONS

These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.

Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991

OBJECTIVE

To examine trends in overweight prevalence and body mass index of the US adult population.

DESIGN

Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.

SETTING/PARTICIPANTS

Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANES II), and 1988 to 1991 (NHANES III phase 1).

RESULTS

In the period 1988 to 1991, 33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.

CONCLUSIONS

These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.

Sustaining community living of the very old: medical and service issues

The unprecedented prolongation of life in the United States has been accompanied by increased numbers of disabled people in their 80s and 90s, who have high needs for health care and social services. The paper reports longitudinal findings on 150 individuals, 85 years and older. Over three years, their functioning on activities of daily living significantly declined at the same time that they continued to described their health as good and to report contentment about their life. Families were active in sustaining community living of the oldest old, but those most at risk of institutionalization were the childless. Over time, 48% of the survivors stayed functionally fit, while 28% became increasingly disabled and dependent and 24% remained stable at a high level of disability. The means by which the oldest old coped with their disabilities include practical steps in simplifying their environment and narrowing their social world. They also used cognitive regulation by modifying their health beliefs and delimiting those areas over which they could exert a sense of control.

Age and velopharyngeal function during speech production

This investigation was designed to determine if velopharyngeal function during speech production, as reflected in measures of nasal air flow, differs with age in adults. Eighty subjects were studied, 40 women and 40 men, representing four age groups (20-30, 40-50, 60-70, and 80 + years). Results showed no age-related differences in nasal air flow. Sex-related differences in flow were found on productions of nasal consonants only. These findings do not support the suggestion of Hutchinson, Robinson, and Nerbonne (1978) that velopharyngeal function deteriorates with age.

1H magnetic resonance spectroscopy in the investigation of intractable epilepsy

We have been using proton magnetic resonance spectroscopy (1H MRS) in the investigation of adults and children with intractable epilepsy. Spectra were obtained from 2 x 2 x 2 cm cubes in the medial region of the temporal lobe, and were analyzed on the basis of signals from N-acetylaspartate (NAA), creatine+phosphocreatine (Cr), and choline-containing compounds (Cho). In comparison with control subjects, the epilepsy patients as a group show significant reductions in the NAA signal and in the NAA/Cho+Cr ratio, with increases in the Cho and Cr signals. The reduction in NAA is interpreted in terms of neuronal loss or damage, while the increase in Cr and Cho signals may be a reflection of reactive astrocytosis.

Constraints and facilitators to friendships in late late life

This report analyzes friendship patterns of individuals 85 and older, 77% of whom are women. Despite high levels of disability and the loss of age peers, the majority were in frequent contact with friends and still had a close friend. Over 31 months, however, the predictors of friendship involvement changed. At Time 1, mood was most important, but by Time 3, increased disability was most important. Qualitative data describe how the constraints and facilitators lead to changing criteria for friendships in late late life.

Families and support networks among African American oldest-old

This article examines the demographic profile of oldest-old African-Americans who reside in the San Francisco Bay Area. Family life and social support available from adult children, relatives, and friends are explored as they vary by gender. Bivariate analyses indicate that females receive more help from relatives and friends, and males receive more help from immediate family members. Parent and childless respondents were compared for instrumental supports. The childless received support from a variety of helpers, whereas, the parents received help from family or the formal sector. Overall, fewer family members were available to assist the oldest-old with community living, although many were able to redefine relationships and increase the numbers of helpers available to assist them. These findings indicate that the principle of substitution operates among some segments of the older African American population, primarily those who are childless. This pattern was more evident among females than among males.

Differential expectations and realities: race, socioeconomic status and health of the oldest-old

Comparisons by race indicate that African Americans are significantly more disadvantaged than whites in their socioeconomic status. Despite complaints about their situation, however, African Americans report that their situation is better than they had expected. Although they perceive their health as poorer than whites, they are no more disabled functionally, and they have significantly better morale. Within-group correlations find the predictable associations between socioeconomic status and physical, psychological, and social outcomes for both groups. Nevertheless, both qualitative and quantitative data indicate that economic well-being is related to the congruence between expectations and the realities of life in advanced old age, making objective and subjective factors of similar importance.

Introduction: social and cultural diversity of the oldest-old

This introduction describes a volume devoted to a much neglected topic and population, the social and cultural diversity among individuals eighty-five years old and older. Four articles come from the San Francisco 85+

STUDY

1) comparisons by Colleen Johnson between whites and African Americans in socioeconomic status, health, and other outcomes; 2) Barbara Barer's analysis of gender differences in the stressors faced in late-life; 3) Charlotte Perry and Colleen Johnson's examination of the families of oldest-old African Americans; 4) Lillian Troll's analysis of white families. The fifth article by Gloria Clayton on rural/urban differences comes from the Georgia Centenarian STUDY. Finally the volume concludes with a commentary by Leonard Pearlin that places these studies into the broader context of aging research.

Safety of combined oligosaccharide conjugate Haemophilus influenzae type b (HbOC) and whole cell diphtheria-tetanus toxoids-pertussis vaccine in infancy. The Kaiser Permanente Pediatric Vaccine Study Group

The safety of the combined oligosaccharide conjugate Haemophilus influenzae (Hib) type b (HbOC) and whole cell diphtheria-tetanus toxoids-pertussis (DTP) vaccine (Tetramune, HbOC-DTP; Lederle) in infancy was evaluated in 6644 recipients of this vaccine and compared with 3914 recipients of separate injections of whole cell DTP and HbOC vaccines when given as a three dose regimen to infants at 2, 4 and 6 months of age in each group. Of the total number of infants in the study, a subset of 1435 were enrolled into the study and then randomly assigned to receive either the Hib-DPT combined vaccine or the separate components. This subset was used to assess local and systemic side effects which were evaluated utilizing telephone interviews 48 to 72 hours after vaccine. The remaining children in the study population were enrolled in a nonrandomized manner. For these children parents were offered the experimental Hib-DPT vaccine and refusers were given HbOC and DTP. Both of these groups of children as well as the randomized subset described above were used to assess rates of episodes of hospitalization, emergency room utilization and sudden infant death syndrome in HbOC-DTP recipients and children who received HbOC and DTP separately. Immunogenicity was evaluated in 123 children by collection of a single serum sample 30 days after the third dose of HbOC-DTP. The observed immunogenicity was comparable to that observed in other recent studies for HbOC and DTP component antigens. The profile of local and systemic side effects observed was virtually identical to that observed after DTP plus HbOC given separately.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium intakes of Mexican Americans, Cubans, Puerto Ricans, non-Hispanic whites, and non-Hispanic blacks in the United States

OBJECTIVE

To compare dietary calcium intakes from food in Mexican Americans, Cubans, Puerto Ricans, non-Hispanic whites, and non-Hispanic blacks aged 11 through 74 years.

DESIGN

Population survey data from the Hispanic Health and Nutrition Examination Survey and the second National Health and Nutrition Examination Survey were used to calculate calcium intake from a single 24-hour recall. These data were compared by age and sex between the five population groups. Food sources of calcium in the three Hispanic groups were also examined using 24-hour recall data.

SUBJECTS

The sample consisted of 11,773 non-Hispanic whites, 1,728 non-Hispanic blacks, 4,739 Mexican Americans, 1,076 Cubans, and 1,835 Puerto Ricans.

MAIN OUTCOME MEASURES

Mean calcium intake, percentage intake of Recommended Dietary Allowance, and, for Hispanics, food sources of calcium.

STATISTICAL ANALYSES

Means were compared within age and sex groups between the five population groups using a t test.

RESULTS

Calcium intakes from food in the three Hispanic groups were similar to intakes of non-Hispanic whites and higher than intakes of non-Hispanic blacks. Although dairy foods were the main sources of calcium for Hispanics, corn tortillas were important calcium sources among Mexican Americans. Women consumed less calcium than the Recommended Dietary Allowance in all age and racial or ethnic groups.

APPLICATIONS

When assessing calcium intakes of the three Hispanic groups, ethnic differences in food sources of calcium need to be considered. Efforts to increase calcium intake in Hispanics also need to account for ethnic differences.

Electromyographic response of peroneal muscles in surgical and nonsurgical injured ankles during sudden inversion

Because the peroneal muscles are thought to act as a safeguard against lateral ankle injury, it is important to study their function. This study was undertaken to electromyographically assess the latency between sudden unexpected ankle inversion and the start of peroneal muscle activity. Three groups participated in the study, including subjects with lateral ankle sprain rehabilitated nonsurgically (N = 7), sprains rehabilitated following surgery (N = 6), and injury-free ankles (N = 11). Peroneal latency was assessed by dropping the subjects into inversion from a special platform. The platform was designed so that either ankle could be inverted to 35 degrees without warning. The ANOVA revealed no significant latency differences (p > .05) between the three groups. The study suggests that bilateral peroneal latency is unaffected by injury. Although it has been thought that healthy muscles provide a defense against ankle sprain, their latency is not permanently affected by ankle injury or by surgery performed to correct defects from injury. It appears that mechanoreceptor impairment may be rehabilitated and that it is not a factor in ankle injury.

Integrating the twelve-step approach with traditional psychotherapy for the treatment of eating disorders

The treatment outcome literature for anorexia nervosa and bulimia indicates that approximately two thirds of patients treated with brief to moderate length interventions have favorable responses. The remaining one third are more difficult to treat and appear to require longer term and more intensive intervention. These patients can usually be characterized as having more severe Axis I and Axis II comorbidity. This manuscript focuses on a longer term treatment program that integrates psychodynamically oriented psychotherapy with a 12-step component. Specific issues that are addressed include the theoretical dilemma between the two models, advantages and disadvantages of adding a 12-step component, and how various subgroups of patients respond to the model. The clinical viability and preliminary impressions regarding outcome with this model are also offered.

Prevalence of high blood cholesterol among US adults. An update based on guidelines from the second report of the National Cholesterol Education Program Adult Treatment Panel

OBJECTIVE

To estimate the current levels and trends in the proportion of US adults with high blood cholesterol based on guidelines from the second report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP II).

DESIGN

Nationally representative cross-sectional surveys.

SETTING/PARTICIPANTS

Data for 7775 participants 20 years of age and older from phase 1 of the third National Health and Nutrition Examination Survey (NHANES III) (data collected from 1988 through 1991) and for 9797 participants 20 through 74 years of age from NHANES II (data collected from 1976 through 1980) were used.

RESULTS

From the data collection period in NHANES II (1976 through 1980) to the period in NHANES III (1988 through 1991), the proportion of adults with high blood cholesterol levels (> or = 240 mg/dL [6.21 mmol bd) fell from 26% to 20%, while the proportion with desirable levels (< 200 mg/dL [5.17 mmol/L]) rose from 44% to 49%. Currently, using the ATP II guidelines and NHANES III data, 40% of all adults 20 years of age and older would require fasting lipoprotein analysis; and 29% of all adults would be candidates for dietary therapy (as compared with 36%, using NHANES II data). Based on 1990 population data, it is estimated that approximately 52 million Americans 20 years of age and older would be candidates for dietary therapy. Assuming that dietary intervention would reduce low-density lipoprotein (LDL) cholesterol levels by 10%, as many as 7% of all adult Americans (approximately 12.7 million) might be candidates for cholesterol-lowering drugs. This estimate reflects approximately 4 million adults with established coronary heart disease, of whom half are aged 65 years and older, and up to 8.7 million adults without established coronary heart disease, of whom up to 3.1 million are aged 65 years and older.

CONCLUSIONS

Substantial progress has been made in reducing the prevalence of high blood cholesterol; yet a large proportion of all adults, approximately 29%, require dietary intervention for high blood cholesterol.

Declining serum total cholesterol levels among US adults. The National Health and Nutrition Examination Surveys

OBJECTIVE

To examine the secular trend in serum total cholesterol levels of the US adult population.

DESIGN

Nationally representative cross-sectional surveys with both an in person interview and a medical examination that included the measurement of blood lipid levels.

SETTING/PARTICIPANTS

Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 through 1962, 1971 through 1974, 1976 through 1980, and 1988 through 1991.

RESULTS

Mean serum total cholesterol levels in US adults aged 20 through 74 years have consistently declined over the time period 1960 through 1991. More than half of the decline occurred during the time period 1976 through 1991. This decline occurred across the entire distribution of serum cholesterol levels and in all age-sex groups. High-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels have not changed, suggesting that the decline in total cholesterol levels is due to a decline in low-density lipoprotein cholesterol levels.

CONCLUSIONS

These results document a continuing and substantial decline in serum cholesterol levels among US adults. They suggest that public health programs, designed to reduce cholesterol levels, are proving successful. The observed downward trend in serum cholesterol levels has coincided with a continuing decline in coronary heart disease mortality. These observations suggest that the Healthy People 2000 goal of reducing the mean serum cholesterol level of US adults to no more than 200 mg/dL (5.17 mmol/L) is attainable.

Issues in the long-term evaluation of diet in longitudinal studies

Longitudinal studies are very useful for studying diet/disease relationships. The fundamental components of a longitudinal study are that: 1) data are collected for two or more distinct time periods; 2) the subjects are the same or comparable from one time period to the next; and 3) data are compared between or among time periods in the analysis. A longitudinal study is often assumed to be synonymous with a cohort study, but there are at least four possible definitions for a longitudinal study. While focusing on cohort studies, the paper describes the nature of longitudinal studies, including a discussion of how the different definitions differ from a cohort study and a set of important assumptions necessary to cohort studies. It also highlights some of the major issues associated with such studies, including the selection of a dietary survey methodology; data collection issues in multicultural, multilingual societies; the importance of nutrient databases; measurement error and misclassification in nutrient intake and energy adjustment.

Management of catastrophic neonatal midgut volvulus with a silo and second-look laparotomy

The case of a neonate with midgut volvulus and severe intestinal ischemia extending from the ligament of Treitz to the midtransverse colon is presented. Management consisted of abdominal silo application at the initial exploration to obviate the adverse physiological consequences of increased intraabdominal pressure from reperfusion edema of the intestine. The majority of the intestine was salvaged, and a short segment of ileum was resected. This method of treatment resulted in optimal ventilatory status, renal function, and cardiac performance. The advantages of temporary prosthetic wound coverage in selected cases of midgut volvulus include greater physiologic stability through the avoidance of "intraabdominal hypertension" and the ability to monitor the status of the intestine at the bedside.