Distribution of 7-year risk of diabetes mellitus among United States adults

Approximately 7.2% of 4739 United States adults had a 7-year risk of > or =21% during 1999-2004. Similar age-adjusted percentages of men and women were at high risk (> or =21%). A larger age-adjusted percentage of Mexican Americans than whites and African Americans were at high risk.

Association of testosterone and sex hormone-binding globulin with metabolic syndrome and insulin resistance in men

OBJECTIVE

We sought to assess the associations of testosterones and sex hormone-binding globulin (SHBG) with metabolic syndrome and insulin resistance in men.

RESEARCH DESIGN AND METHODS

We defined metabolic syndrome according to the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Among men aged >or=20 years who participated in the Third National Health and Nutrition Examination Survey (n = 1,226), the Cox proportional hazards model was used to estimate the prevalence ratio and 95% CI of metabolic syndrome according to circulating concentrations of testosterones and SHBG.

RESULTS

After adjustment for age, race/ethnicity, smoking status, alcohol intake, physical activity level, LDL cholesterol, C-reactive protein, and insulin resistance, men in the first quartile (lowest) (prevalence ratio 2.16 [95% CI 1.53-3.06]) and second quartile of total testosterone (2.51 [1.86-3.37]) were more likely to have metabolic syndrome than men in the fourth quartile (highest, referent group) (P < 0.001 for linear trend). Similarly, men in the first quartile of SHBG (2.17 [1.32-3.56]) were more likely to have metabolic syndrome than men in the fourth quartile (P = 0.02 for linear trend). No significant associations of calculated free testosterone (P = 0.31 for linear trend) and bioavailable testosterone (P = 0.11 for linear trend) with metabolic syndrome were detected after adjustment for all possible confounders.

CONCLUSIONS

Low concentrations of total testosterone and SHBG were strongly associated with increased likelihood of having metabolic syndrome, independent of traditional cardiovascular risk factors and insulin resistance.

Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, 2005-2006

OBJECTIVE

To estimate the prevalence of self-reported clinically diagnosed sleep apnea (diagnosed sleep apnea) according to body mass index (BMI, measure of total obesity) and waist circumference (measure of abdominal obesity) in US adults.

METHODS

Data from a representative sample of 4309 US adults in the National Health and Nutrition Examination Surveys 2005-2006 were analyzed. Log-linear regression analyses with a robust variance estimator were performed to estimate the prevalence ratios (PR) and 95% confidence intervals (CIs).

RESULTS

The overall crude and age-adjusted prevalence estimates of diagnosed sleep apnea were 4.7% (95% CI=4.0%-5.5%) and 4.5% (95% CI=3.9%-5.2%) in adults. Age-adjusted prevalence in men (6.1%, 95% CI=5.0%-7.3%) was higher than that in women (3.1%, 95% CI=2.1%-4.0%; P<0.01). Age-adjusted prevalence was higher for persons with total obesity (i.e., BMI > or = 30 kg/m(2)) (12.1% vs. 3.0% in men, P<0.01; 7.0% vs. 0.7% in women, P<0.01) or abdominal obesity (10.9% vs. 1.9% in men, P<0.01; 4.6% vs. 0.6% in women, P<0.01) than that for those without total obesity (BMI <30 kg/m(2)) or without abdominal obesity.

CONCLUSIONS

These results from a nationally representative sample suggest that diagnosed sleep apnea is highly prevalent among adults with obesity in the general population, especially among men.

Waist-to-thigh ratio and diabetes among US adults: the Third National Health and Nutrition Examination Survey

AIMS

We sought to examine whether waist-to-thigh ratio (WTR) performed better than waist-to-height ratio (WHtR), waist-to-hip ratio (WHpR), waist circumference (WC), or body mass index (BMI) in relation to diabetes among US adults.

METHODS

Data of 6277 men and nonpregnant women 20 years or older from the Third National Health and Nutrition Examination Survey (1988-1994) were analyzed.

RESULTS

In men, AUC of WTR (0.83) was larger than that of WHtR (0.78) (P=0.003), WHpR (0.79) (P<0.001), WC (0.76) (P<0.001), and BMI (0.72) (P<0.001) for diabetes. In women, the AUC of WTR (0.80) was similar to that of WHtR (0.80) (P=0.89), WHpR (0.79) (P=0.55), and WC (0.78) (P=0.36), but larger than that of BMI (0.73) (P=0.03) for diabetes. After adjustment for potential confounders, WTR had the strongest association with diabetes in men (OR, 2.13; 95% CI, 1.57-2.88; per 1 SD increment), whereas WHpR had the strongest association with diabetes in women (OR, 1.94; 95% CI, 1.60-2.35).

CONCLUSIONS

WTR performed better than other four indices in men and WTR performed similarly to WHtR, WHpR, and waist circumference, but better than BMI in women for the association with diabetes.

Physical activity and optimal self-rated health of adults with and without diabetes

BACKGROUND

Regular physical activity can improve people's overall health and contribute to both primary and secondary prevention of many chronic diseases and conditions including diabetes. The aim of this study was to examine the association between levels of physical activity and optimal self-rated health (SRH) of U.S. adults with and without diabetes in all 50 states and territories of the Unites States.

METHODS

We estimated the prevalence of optimal SRH by diabetes status of 430,912 adults aged 18 years and older who participated in the 2007 state-based survey of the Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using levels of physical activity as a predictor and status of optimal SRH as an outcome variable while controlling for sociodemographic and behavioral health risk factors.

RESULTS

The prevalence of reporting optimal SRH was 53.3%, 52.2%, and 86.2% for adults with type 1 diabetes, type 2 diabetes, and without diabetes, respectively. Also in the aforementioned order, adults who reported being active had an increased likelihood of 81%, 32%, and 18% for reporting optimal SRH, when compared with adults who reported being inactive.

CONCLUSIONS

Regular physical activity of adults, particularly adults with diabetes, is associated with optimal SRH. The findings of this study underscore the importance of advising and motivating adults with diabetes so that physical activity can be integrated into their lifestyle for diabetes care. Additionally, a population-based effort to promote physical activity in communities may benefit adults in general by improving their overall health and well-being.

Binge drinking and suboptimal self-rated health among adult drinkers

BACKGROUND

Binge drinking accounts for more than half of the 79,000 annual deaths in the United States that are owing to excessive drinking. The overall objective of our study was to examine the prevalence of binge drinking and consumption levels associated with suboptimal self-rated health among the general population of adult drinkers in all 50 states and territories in the United States.

METHODS

The study included a total of 200,587 current drinkers who participated in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey. We estimated the prevalence of binge drinking (i.e., > or =5 drinks on 1 occasion for men or > or =4 drinks on 1 occasion for women) and heavy drinking (i.e., an average of >14 drinks per week for men or >7 drinks per week for women), as well as the average number of binge episodes per person during a 30-day period. Odds ratios were produced with multivariate logistic regression models using binge-drinking levels as a predictor; status of suboptimal self-rated health was used as an outcome variable while controlling for sociodemographic, health, and behavioral risk factors.

RESULTS

We estimate that 34.7 million adult drinkers in the United States engaged in binge drinking in 2008, including an estimated 42.2% who reported either heavy drinking or at least 4 binge-drinking episodes in a 30-day period. Binge drinking with such levels was associated with a 13-23% increased likelihood of reporting suboptimal self-rated health, when compared to the nonbinge drinkers.

CONCLUSIONS

Binge drinking continues to be a serious public health concern. Frequent binge drinkers or binge drinkers who consume alcohol heavily are especially at risk of suboptimal self-rated health. Our findings underscore the importance of broad-based implementation in health care settings of screening for and brief interventions to address alcohol misuse, as well as the continuing need to implement effective population-based prevention strategies to reduce alcohol-related morbidity and mortality.

Lifestyle factors and mortality among adults with diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study*

BACKGROUND

Healthy lifestyle behaviors are among the cornerstones of diabetes self-management, but the extent to which healthy lifestyle factors could potentially prevent premature mortality among people with diabetes remains unknown. The aim of the present study was to estimate the reduction in mortality that could be achieved if people with diabetes did not smoke, had a body mass index <30 kg/m(2) , performed physical activity for ≥3.5 h/week, reported better dietary habits, and consumed alcohol moderately.

METHODS

A prospective cohort study of 1263 German men and women with diabetes aged 35-65 years who were followed for an average of 7.8 years was used and multivariate Cox regression models for all-cause and cause-specific mortality were calculated.

RESULTS

Approximately 7% of study participants had no favorable factors, 24% had one, 35% had two, and 34% had three or more. Compared with participants who had no favorable factors, the reduction in risk was 34% [95% confidence interval (CI) 19%, 63%] for those with one favorable factor, 49% (95% CI 9%, 71%) for those with two, and 63% (95% CI 31%, 80%) for those with three or more. Furthermore, a competing risk analysis did not show any difference in the inverse associations with mortality due to cardiovascular disease, cancer, or other causes.

CONCLUSIONS

Favorable lifestyle factors can potentially achieve substantial reductions in premature mortality among people with diabetes. Our results emphasize the importance of helping people with diabetes optimize their lifestyle behaviors.

Undertreatment of mental health problems in adults with diagnosed diabetes and serious psychological distress: the behavioral risk factor surveillance system, 2007

OBJECTIVE

To assess the prevalence and correlates of undertreatment for mental health problems among adults with diabetes and serious psychological distress (SPD).

RESEARCH DESIGN AND METHODS

We analyzed data of adults aged >or=18 years from the 2007 Behavioral Risk Factor Surveillance System. SPD was assessed with the Kessler-6 scale.

RESULTS

The prevalence of untreated SPD was estimated to be 2.1 +/- 0.1% (mean +/- SE), 3.4 +/- 0.3%, and 2.0 +/- 0.1% in the total population, diabetic population, and nondiabetic population, respectively. Among people with SPD, those with diagnosed diabetes had a lower rate of undertreatment for mental health problems (45.0%) than those without diabetes (54.9%) (P = 0.002). Nonwhite race/ethnicity, advanced age, lack of health insurance, and currently being employed were associated with increased likelihood of undertreatment for mental health problems (P < 0.05).

CONCLUSIONS

People with diagnosed diabetes may be screened for SPD and treated for specific mental health problems in routine health care.

Television watching and incident diabetes: Findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study

BACKGROUND

The aim of the present study was to examine whether the amount of time spent watching television is a potential risk factor for incident diabetes and to what extent this association may be explained by obesity.

METHODS

We used data for 23,855 men and women from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study. During an average of 7.8 years of follow-up, 927 participants developed diabetes. Incident diabetes was identified on the basis of self-report and was verified by contacting the patient's attending physician. The amount of time spent watching television was self-reported.

RESULTS

The mean time that the participants who developed diabetes watched television was 2.4 h/week, compared with 2.0 h/week for those who did not develop diabetes (P<0.001). After adjusting for age, sex, educational status, smoking status, alcohol use, occupational activity, physical activity, the intake of various foods, and systolic blood pressure, the adjusted hazard ratio for diabetes among participants who watched ≥4 h/day of television compared with those who watched <1 h/day was 1.63 [95% confidence interval (CI): 1.17-2.27]. After additional adjustment for waist circumference and body mass index, the hazard ratio was reduced to 1.14 (95% CI: 0.81-1.61).

CONCLUSIONS

In the present study, the amount of time spent watching television was an independent predictor of incident diabetes only in models that adjusted for sociodemographic characteristics, lifestyle behaviors, and systolic blood pressure. The attenuation of the association after adjusting for anthropometric measures may represent an explanatory mechanism for our findings.

Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006

OBJECTIVE We examined prevalences of previously diagnosed diabetes and undiagnosed diabetes and high risk for diabetes using recently suggested A1C criteria in the U.S. during 2003-2006. We compared these prevalences to those in earlier surveys and those using glucose criteria. RESEARCH DESIGN AND METHODS In 2003-2006, the National Health and Nutrition Examination Survey included a probability sample of 14,611 individuals aged > or =12 years. Participants were classified on glycemic status by interview for diagnosed diabetes and by A1C, fasting, and 2-h glucose challenge values measured in subsamples. RESULTS Using A1C criteria, the crude prevalence of total diabetes in adults aged > or =20 years was 9.6% (20.4 million), of which 19.0% was undiagnosed (7.8% diagnosed, 1.8% undiagnosed using A1C > or =6.5%). Another 3.5% of adults (7.4 million) were at high risk for diabetes (A1C 6.0 to <6.5%). Prevalences were disproportionately high in the elderly. Age-/sex-standardized prevalence was more than two times higher in non-Hispanic blacks and Mexican Americans versus non-Hispanic whites for diagnosed, undiagnosed, and total diabetes (P < 0.003); standardized prevalence at high risk for diabetes was more than two times higher in non-Hispanic blacks versus non-Hispanic whites and Mexican Americans (P < 0.00001). Since 1988-1994, diagnosed diabetes generally increased, while the percent of diabetes that was undiagnosed and the percent at high risk of diabetes generally decreased. Using A1C criteria, prevalences of undiagnosed diabetes and high risk of diabetes were one-third that and one-tenth that, respectively, using glucose criteria. CONCLUSIONS Although A1C detects much lower prevalences than glucose criteria, hyperglycemic conditions remain high in the U.S., and elderly and minority groups are disproportionately affected.

Associations of serum concentrations of 25-hydroxyvitamin D and parathyroid hormone with surrogate markers of insulin resistance among U.S. adults without physician-diagnosed diabetes: NHANES, 2003-2006

OBJECTIVE

To examine whether concentrations of serum 25-hydroxyvitamin D (25[OH]D) and parathyroid hormone (PTH) are associated with surrogate markers of insulin resistance (IR) in U.S. adults without physician-diagnosed diabetes.

RESEARCH DESIGN AND METHODS

Cross-sectional data (n = 3,206) from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 were analyzed.

RESULTS

The age-adjusted prevalence of hyperinsulinemia, high homeostasis model assessment-IR, high GHb, and fasting and 2-h hyperglycemia decreased linearly across quintiles of 25(OH)D but increased linearly across quintiles of PTH (except for a quadratic trend for fasting hyperglycemia). After extensive adjustment for potential confounders, the relationships between 25(OH)D and the markers of IR and 2-h hyperglycemia persisted. Only hyperinsulinemia was positively associated with PTH (P < 0.05).

CONCLUSIONS

Among U.S. adults without physician-diagnosed diabetes, low concentrations of serum 25(OH)D were associated with markers of IR. The role of PTH in IR deserves further investigation.

Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America

OBJECTIVE

To examine the potential for reducing cardiovascular risk factors in the United States of America enough to cause age-adjusted coronary heart disease (CHD) mortality rates to drop by 20% (from 2000 baseline figures) by 2010, as targeted under the Healthy People 2010 initiative.

METHODS

Using a previously validated, comprehensive CHD mortality model known as IMPACT that integrates trends in all the major cardiovascular risk factors, stratified by age and sex, we calculated how much CHD mortality would drop between 2000 and 2010 in the projected population of the United States aged 25-84 years (198 million). We did this for three assumed scenarios: (i) if recent risk factor trends were to continue to 2010; (ii) success in reaching all the Healthy People 2010 risk factor targets, and (iii) further drops in risk factors, to the levels already seen in the low-risk stratum.

FINDINGS

If age-adjusted CHD mortality rates observed in 2000 remained unchanged, some 388,000 CHD deaths would occur in 2010. First scenario: if recent risk factor trends continued to 2010, there would be approximately 19,000 fewer deaths than in 2000. Although improved total cholesterol, lowered blood pressure in men, decreased smoking and increased physical activity would account for some 51,000 fewer deaths, these would be offset by approximately 32,000 additional deaths from adverse trends in obesity and diabetes and in blood pressure in women. Second scenario: If Healthy People 2010 cardiovascular risk factor targets were reached, approximately 188,000 CHD deaths would be prevented. Scenario three: If the cardiovascular risk levels of the low-risk stratum were reached, approximately 372,000 CHD deaths would be prevented.

CONCLUSION

Achievement of the Healthy People 2010 cardiovascular risk factor targets would almost halve the predicted CHD death rates. Additional reductions in major risk factors could prevent or postpone substantially more deaths from CHD.

Serum concentrations of vitamin D and parathyroid hormone and prevalent metabolic syndrome among adults in the United States

BACKGROUND

Some reports suggest that concentrations of vitamin D are inversely, whereas concentrations of parathyroid hormone (PTH) are directly, associated with prevalent metabolic syndrome. Because of lingering uncertainty about these associations, we examined the cross-sectional associations between serum concentrations of 25-hydroxyvitamin D(3) and PTH with metabolic syndrome in a representative sample of adults in the US.

METHODS

We used data from 1705 participants in the 2005-2006 National Health and Nutrition Examination Survey. Vitamin D was measured by radioimmunoassay, whereas PTH was measured using an electrochemiluminescent process.

RESULTS

The mean concentration of vitamin D for participants with and without metabolic syndrome was 20.3 and 22.9 ng/mL, respectively (P = 0.001). The mean concentration of PTH for participants with and without metabolic syndrome was 44.5 and 41.0 pg/mL, respectively (P = 0.002). The age-adjusted mean concentrations of vitamin D (P for linear trend <0.001) decreased linearly, whereas PTH (P for linear trend = 0.002) increased linearly, as the number of components of metabolic syndrome increased. After adjusting for age, gender, physical activity, urinary albumin creatinine ratio, and concentrations of C-reactive protein and calcium, concentrations in the highest quintile of vitamin D [prevalence ratio (PR) = 0.59; 95% confidence interval (CI) 0.44-0.79], but not PTH (PR = 1.18; 95% CI 0.97-1.43), was significantly associated with prevalent metabolic syndrome.

CONCLUSION

Concentrations of vitamin D, but not PTH, were significantly associated with prevalent metabolic syndrome among US adults.

Estimates of body composition with dual-energy X-ray absorptiometry in adults

BACKGROUND

Little is known about the distributions of percentage body fat (PBF), total body fat (TBF), and fat-free mass (FFM) in the adult population in the United States.

OBJECTIVES

We sought to estimate the means and percentile cutoffs of PBF, TBF, and FFM and to assess the differences by sex, age, race-ethnicity, and body mass index in US adults.

DESIGN

Data from the National Health and Nutrition Examination Survey (NHANES), which were collected during the 6-y period from 1999 to 2004 and comprise a large nationally representative sample of the US population, were analyzed (n = 6559 men and 6507 nonpregnant women). TBF and FFM were measured by using dual-energy X-ray absorptiometry. PBF was calculated as TBF divided by total mass multiplied by 100.

RESULTS

There were large differences between men and women in unadjusted mean PBF (28.1% compared with 40.0%, P < 0.001), TBF (25.4 compared with 30.8 kg, P < 0.001), and FFM (62.3 compared with 44.0 kg, P < 0.001); the sex differences persisted across all body mass index categories after adjustment for age and race-ethnicity (all P < 0.001). The common percentile cutoffs of PBF, TBF, and FFM were estimated by sex, race-ethnicity, and age groups. Equations for the estimation of PBF (R(2) = 0.85), TBF (R(2) = 0.94), and FFM (R(2) = 0.94) according to demographic characteristics and simple anthropometric measures were generated.

CONCLUSION

The estimates of means and percentile cutoffs for PBF, TBF, and FFM, on the basis of NHANES 1999-2004 dual-energy X-ray absorptiometry data, provide a reference in the US adult population.

The impact of obesity on time spent with the provider and number of medications managed during office-based physician visits using a cross-sectional, national health survey

Background

Obesity is associated with morbidity, mortality, and increased health care costs. Few studies have examined the impact of obesity on outpatient office visits. The purpose of this study was to determine if outpatient visits by obese persons required more time with the provider and more prescription medication management compared to visits made by non-obese persons.

Methods

Obesity status was determined for 9,280 patient visits made by persons aged 18 years or older in the 2006 National Ambulatory Medical Care Survey. Multivariate analyses compared obese and non-obese visits, stratified by sex, for duration of the visit and the number of medications mentioned at the visit.

Results

Average duration of visit was higher among visits with patients determined to be obese. However, these differences were not considered significant after statistical testing. Visits made by obese female patients were significantly more likely to involve more than two prescription medications (OR 1.26, 95% CI 1.05 - 1.51) and visits made by obese male patients were significantly more likely to involve more than two prescription medications (OR 1.46, 95% CI 1.16 - 1.83) as compared to visits made by non-obese patients.

Conclusion

Time spent with the provider was found to be greater among visits with obese patients, but not significantly different from visits with non-obese patients. The number of medications for each visit was found to be significantly greater for visits where the patient was considered to be obese. Increased time for the visit and increased numbers of medication for each visit translate into increased costs. These findings document the impact of obesity on our health care system and have great implications on medical care cost and planning.

Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003-2004 National Health and Nutrition Examination Survey (NHANES)

BACKGROUND

Vitamin C (ascorbic acid) may be the most important water-soluble antioxidant in human plasma. In the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), approximately 13% of the US population was vitamin C deficient (serum concentrations <11.4 micromol/L).

OBJECTIVE

The aim was to determine the most current distribution of serum vitamin C concentrations in the United States and the prevalence of deficiency in selected subgroups.

DESIGN

Serum concentrations of total vitamin C were measured in 7277 noninstitutionalized civilians aged > or =6 y during the cross-sectional, nationally representative NHANES 2003-2004. The prevalence of deficiency was compared with results from NHANES III.

RESULTS

The overall age-adjusted mean from the square-root transformed (SM) concentration was 51.4 micromol/L (95% CI: 48.4, 54.6). The highest concentrations were found in children and older persons. Within each race-ethnic group, women had higher concentrations than did men (P < 0.05). Mean concentrations of adult smokers were one-third lower than those of nonsmokers (SM: 35.2 compared with 50.7 micromol/L and 38.6 compared with 58.0 micromol/L in men and women, respectively). The overall prevalence (+/-SE) of age-adjusted vitamin C deficiency was 7.1 +/- 0.9%. Mean vitamin C concentrations increased (P < 0.05) and the prevalence of vitamin C deficiency decreased (P < 0.01) with increasing socioeconomic status. Recent vitamin C supplement use or adequate dietary intake decreased the risk of vitamin C deficiency (P < 0.05).

CONCLUSIONS

In NHANES 2003-2004, vitamin C status improved, and the prevalence of vitamin C deficiency was significantly lower than that during NHANES III, but smokers and low-income persons were among those at increased risk of deficiency.

Trends in the prevalence of low risk factor burden for cardiovascular disease among United States adults

BACKGROUND

Cohorts consistently show that individuals with low levels of cardiovascular risk factors experience low rates of subsequent cardiovascular events. Our objective was to examine the prevalence and trends in low risk factor burden for cardiovascular disease among adults in the US population.

METHODS AND RESULTS

We used data from adults 25 to 74 years of age who participated in 4 national surveys. We created an index of low risk from the following variables: not currently smoking, total cholesterol <5.17 mmol/L (<200 mg/dL) and not using cholesterol-lowering medications, systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg and not using antihypertensive medications, body mass index <25 kg/m(2), and not having been previously diagnosed with diabetes mellitus. The age-adjusted prevalence of low risk factor burden increased from 4.4% during 1971 to 1975 to 10.5% during 1988 to 1994 before decreasing to 7.5% during 1999 to 2004 (P for nonlinear trend <0.001). The patterns were similar for men and women, although the prevalence among women exceeded that among men in each survey (P<0.001 for each survey). In addition, whites had a significantly higher prevalence of low risk factor burden than blacks during each survey except during 1976 to 1980 (1971 to 1975, 1988 to 1994, 1999 to 2004: P<0.001; 1976 to 1980: P=0.154). Furthermore, a larger percentage of whites had a low risk factor burden than Mexican Americans during 1988 to 1994 (P<0.001) and 1999 to 2004 (P=0.001).

CONCLUSIONS

The prevalence of low risk factor burden for cardiovascular disease is low. The progress that had been made during the 1970s and 1980s reversed in recent decades.

Patterns of change in cardiometabolic risk factors associated with the metabolic syndrome among children and adolescents: the Fels Longitudinal Study

OBJECTIVES

To examine the patterns of change in cardiometabolic risk factors associated with the metabolic syndrome in children and adolescents between the ages of 8 to 19 years.

STUDY DESIGN

Data of children and adolescents who participated in the Fels Longitudinal Study were analyzed. Body mass index, waist circumference, fasting insulin, fasting glucose, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure were assessed annually with a standardized protocol.

RESULTS

The proportion of participants having at least 1 change between states of high and normal risk ranged from of 11.0% for body mass index to 30.4% for triglycerides. Youth in the high-risk category at baseline had a higher proportion having changed their status for all risk factors (all P < .05) except waist circumference compared with those in the normal-risk category. There were significant time effects for all risk factors (all P < .01) except fasting glucose and triglyceride levels in metric scores, but insignificant time effects for all risk factors in Z-scores in growth curve analyses.

CONCLUSIONS

The cardiometabolic risk factors associated with the MetS were relatively stable among white children and adolescents in the normal risk category. Changes in status were common if the risk factor was elevated.

Determinants of Quality of Life Among People with Asthma: Findings from the Behavioral Risk Factor Surveillance System

Asthma is a major contributor to impaired quality of life in the U.S. population. Little is known about population-based determinants of quality of life among people with asthma, however. Using data from the 2000 Behavioral Risk Factor Surveillance System, we examined the associations between selected sociodemographic, behavioral, and other determinants and quality of life among 12,111 participants with current asthma. In multiple logistical regression models, three variables--employment status, smoking status, and physical activity--were significantly associated with all measures of impaired quality of life (poor or fair health, > or = 14 physically unhealthy days, > 14 mentally unhealthy days, > or = 14 activity limitation days, or > or = 14 physically or mentally unhealthy days). Education was significantly and inversely related to impaired quality of life for all measures except activity limitation days. Men were less likely than women to report having > or = 14 physically unhealthy days, > or = 14 mentally unhealthy days, or > or = 14 physically or mentally unhealthy days. Compared with whites, Hispanics were more likely to report being in poor or fair health, and African Americans were less likely to report having > or = 14 physically unhealthy days or > or = 14 physically or mentally unhealthy days. In addition, participants with lower incomes were more likely to report impaired quality of life for three measures (general health status, > or = 14 physically unhealthy days, and activity limitation days). The heaviest participants were more likely to be in poor or fair health or to report having more > or = 14 physically unhealthy days, or > or = 14 physically or mentally unhealthy days. Insurance coverage and the time since their last routine checkup were not significantly associated with any of the quality-of-life measures. These results show that three potentially modifiable factors (smoking status, physical activity, body mass index) are associated with quality of life among persons with asthma. Furthermore, among people with asthma, the elderly, women, poorly educated, and low-income participants are especially likely to experience impaired quality of life.

Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study

BACKGROUND

Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease, diabetes, and cancer associated with 4 healthy lifestyle factors among German adults.

METHODS

We used data from 23,153 German participants aged 35 to 65 years from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. End points included confirmed incident type 2 diabetes mellitus, myocardial infarction, stroke, and cancer. The 4 factors were never smoking, having a body mass index lower than 30 (calculated as weight in kilograms divided by height in meters squared), performing 3.5 h/wk or more of physical activity, and adhering to healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption). The 4 factors (healthy, 1 point; unhealthy, 0 points) were summed to form an index that ranged from 0 to 4.

RESULTS

During a mean follow-up of 7.8 years, 2006 participants developed new-onset diabetes (3.7%), myocardial infarction (0.9%), stroke (0.8%), or cancer (3.8%). Fewer than 4% of participants had zero healthy factors, most had 1 to 3 healthy factors, and approximately 9% had 4 factors. After adjusting for age, sex, educational status, and occupational status, the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased. Participants with all 4 factors at baseline had a 78% (95% confidence interval [CI], 72% to 83%) lower risk of developing a chronic disease (diabetes, 93% [95% CI, 88% to 95%]; myocardial infarction, 81% [95% CI, 47% to 93%]; stroke, 50% [95% CI, -18% to 79%]; and cancer, 36% [95% CI, 5% to 57%]) than participants without a healthy factor.

CONCLUSION

Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases.

Associations of health risk factors and chronic illnesses with life dissatisfaction among U.S. adults: the Behavioral Risk Factor Surveillance System, 2006

OBJECTIVE

To estimate the prevalence of life dissatisfaction and assess its associations with health risk factors and chronic illnesses in adults.

METHODS

Data from the Behavioral Risk Factor Surveillance System in 2006 (n=341,140) were analyzed. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using logistic regression analyses.

RESULTS

The prevalence of life dissatisfaction was estimated to be 5.0% among adults. People with one, two, and three health risk factors were, respectively, 2.2 (95% CI: 2.0-2.5), 3.7 (95% CI: 3.2-4.2), and 5.8 (95% CI: 4.6-7.4) times more likely to report life dissatisfaction than those without (P<0.0001 for linear trend). People with one, two, and three or more chronic illnesses were, respectively, 1.8 (95% CI: 1.7-2.0), 3.6 (95% CI: 3.2-4.0), and 5.0 (95% CI: 4.4-5.7) times more likely to report life dissatisfaction than those without (P<0.0001). After adjustment for self-rated health and other potential confounding variables, the associations were attenuated but remained significant for the number of health risk factors (P<0.0001 for linear trend) and the number of chronic illnesses (P<0.001).

CONCLUSIONS

Clustering of health risk factors or chronic illnesses was associated with life dissatisfaction independently of self-rated health and other established correlates.

Life-years gained among US adults from modern treatments and changes in the prevalence of 6 coronary heart disease risk factors between 1980 and 2000

Has the recent US decline in coronary heart disease (CHD) mortality increased life expectancy? The authors estimated the number of life-years gained from CHD treatments and changes in the prevalence of cardiovascular disease risk factors for the US population between 1980 and 2000. The previously validated IMPACT model was used to integrate data on numbers of CHD patients, treatment uptake, treatment effectiveness, population risk factor trends, and median survival among US adults. There were 308,900 fewer CHD deaths in 2000 among Americans aged 25-84 years than if 1980 mortality rates had applied. These 308,900 fewer deaths represented approximately 3,147,800 life-years gained (sensitivity analysis range, 2,448,900-3,744,900). Treatments for patients accounted for approximately 1,092,400 (751,700-1,387,000) life-years gained, whereas changes in the prevalence of population risk factors accounted for a gain of 2,055,500 (1,697,200-2,346,300) life-years. However, the 2,770,500 life-years gained through decreased levels of smoking, cholesterol, blood pressure, and physical inactivity were diminished by a loss of 715,000 life-years attributable to increased rates of obesity and diabetes. Therefore, modest reductions in the prevalence of several major cardiovascular disease risk factors accounted for more than twice as many life-years gained as did treatments. Unfortunately, these gains were partially offset by substantial increases in obesity and diabetes.