Metabolic syndrome rates in United States adolescents, from the National Health and Nutrition Examination Survey, 1999-2002

OBJECTIVE

To report the prevalence rates of the metabolic syndrome in a nationally representative sample of adolescents in the United States using 4 previously reported definitions of the syndrome.

STUDY DESIGN

Data from 12- to 19-year-old adolescents included in the National Health and Nutrition Examination Survey from 1999 to 2002 (NHANES 99-02) were analyzed by cross-sectional methods, by using 4 definitions of the metabolic syndrome previously applied to adolescents.

RESULTS

In NHANES 99-02, the prevalence of the metabolic syndrome in all teens varied from 2.0% to 9.4% of teens in the United States, depending on the definition used. In obese teens, these prevalence rates varied from 12.4% to 44.2%. In the group of obese teens, application of the definition by Cruz produced a metabolic syndrome prevalence rate of 12.4%; that of Caprio produced a rate of 14.1%. However, none of the normal weight or overweight teens met either definition. Application of the definition by Cook produced a prevalence rate of 7.8% in overweight teens and 44% in obese teens. The adult definition of metabolic syndrome produced a prevalence rate of 16% in overweight teens and 26% in obese teens.

CONCLUSIONS

In the period between 1999 and 2002, the prevalence rate of metabolic syndrome varied from just >9% to as low as 2% of adolescents overall. Different definitions of metabolic syndrome generated prevalence rates in obese adolescents that varied widely from 12% to 44%. For this syndrome to be a useful construct, a more standardized set of criteria may be needed.

Compliance with physical activity recommendations in US adults with diabetes

AIMS

To investigate whether US adults with diabetes meet both the national and American Diabetes Association (ADA) recommendations for physical activity compared with people without diabetes, and to examine the trends of this behaviour over time.

METHODS

We analysed data from large nationally representative cohorts from the 1996-2005 Behavioral Risk Factor Surveillance System. The number of participants ranged from 98 127 in 1996 to 204,977 in 2005, and the number of people with diabetes ranged from 4379 in 1996 to 13,608 in 2005. Participants were classified by their exercise status and physical activity levels. The age-standardized prevalence of physical activity participation or meeting physical activity recommendations was calculated in people with and without diabetes.

RESULTS

People with diabetes participated less in physical activity (63.1-68.9 vs. 71.7-78.3%) and met physical activity recommendations less than people without diabetes (40.2-42.9 vs. 48.0-51.5% for meeting national recommendations and 38.5-41.7 vs. 46.6-49.8% for meeting ADA recommendations). The percentage of people with diabetes who participated in physical activity in the past 10 years or met physical activity recommendations in the past 5 years did not vary, whereas significantly increasing trends were observed in people without diabetes. The odds for adults with diabetes meeting physical activity recommendations were significantly lower than in adults without diabetes even after multivariate adjustment.

CONCLUSION

People with diabetes were less likely to meet either national or ADA recommendations for physical activity than people without diabetes. Our results demonstrate the need for more efforts from health-care professionals to promote physical activity in people with diabetes.

Language preference as a predictor of access to and use of healthcare services among Hispanics in the United States

OBJECTIVES

The objective of this study was to determine if Spanish language preference was significantly associated with barriers to healthcare services among a nationally representative sample of Hispanic persons in the United States.

DESIGN

Cross-sectional analysis of secondary data. Differences in outcomes between those responding in Spanish and those responding in English were tested using chi-square analyses and multiple logistic regression models.

SETTING

Nationally representative sample of US adults responding to the 2005 Behavioral Risk Factor Surveillance System survey.

PARTICIPANTS

Respondents identifying themselves as Hispanic (n = 20,400).

MAIN OUTCOME MEASURES

Four health care outcomes including health insurance coverage, having a personal health care provider, forgoing care because of cost, and having a routine check-up within the past five years.

RESULTS

Those responding in Spanish were less likely to have healthcare coverage, less likely to have a personal healthcare provider, and less likely to have had a routine check-up within the past five years. No difference was found for indicating that cost was a barrier to receiving care in this model.

CONCLUSIONS

Disparities in healthcare access exist between Hispanic persons in the United States whose language preference is Spanish and those whose language preference is English. In an effort to achieve Healthy People 2010 goals and to provide care to all persons in the United States, barriers to care, such as language preference, should be addressed more fully in our healthcare system.

Prevalence of depression among U.S. adults with diabetes: findings from the 2006 behavioral risk factor surveillance system

OBJECTIVE

To estimate the prevalence rate of depression among adults with diabetes using a large population-based sample in the U.S.

RESEARCH DESIGN AND METHODS

Data from the 2006 Behavioral Risk Factor Surveillance System, a standardized telephone survey among U.S. adults aged >or=18 years, were analyzed (n = 18,814). The Patient Health Questionnaire diagnostic algorithm was used to identify major depression.

RESULTS

The age-adjusted prevalence rate of major depression was 8.3% (95% CI 7.3-9.3), ranging from a low of 2.0% in Connecticut to a high of 28.8% in Alaska. There were 25-fold differences in the rate among racial/ethnic subgroups (lowest, 1.1% among Asians; highest, 27.8% among American Indians/Alaska Natives). People with type 2 diabetes who were currently using insulin had a higher rate than people with type 1 diabetes (P = 0.0009) and those with type 2 diabetes who were currently not using insulin (P = 0.01).

CONCLUSIONS

Major depression was highly prevalent among people with diabetes; the prevalence rate varied greatly by demographic characteristics and diabetes types.

The associations between smoking, physical inactivity, obesity, and asthma severity in the general US population

The purpose of this study was to examine the associations between smoking, physical inactivity, obesity, and asthma severity among US adults. The magnitude of these associations was very strong. For example, those who visited an emergency room in the past year were 60% more likely than those who did not to smoke; those who used an inhaler > or =15 times in the past month (versus those who did not use an inhaler) were 90% more likely to be physically inactive; and those who had asthma symptoms all the time in the past 30 days (versus those with no symptoms) were 80% more likely to be obese.

Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates

OBJECTIVES

The objective of our study was to examine age-specific mortality rates from coronary heart disease (CHD), particularly those among younger adults.

BACKGROUND

Trends for obesity, diabetes, blood pressure, and metabolic syndrome among young adults raise concerns about the mortality rates from CHD in this group.

METHODS

We used mortality data from 1980 to 2002 to calculate age-specific mortality rates from CHD for U.S. adults age > or =35 years.

RESULTS

Overall, the age-adjusted mortality rate decreased by 52% in men and 49% in women. Among women age 35 to 54 years, the estimated annual percentage change (EAPC) in mortality was -5.4% (95% confidence interval [CI] -5.8 to -4.9) from 1980 until 1989, -1.2% (95% CI -1.6 to -0.8) from 1989 until 2000, and 1.5% (95% CI -3.4 to 6.6) from 2000 until 2002. Among men age 35 to 54 years, the EAPC in mortality was -6.2% (95% CI -6.4 to -5.9) from 1980 until 1989, -2.3% (95% CI -2.6 to -2.1) from 1989 until 2000, and -0.5% (95% CI -3.7 to 2.9) from 2000 until 2002. Among women and men age > or =55 years, the estimated annual percentage decrease in mortality from CHD accelerated in more recent years compared with earlier periods.

CONCLUSIONS

The mortality rates for CHD among younger adults may serve as a sentinel event. Unfavorable trends in several risk factors for CHD provide a likely explanation for the observed mortality rates.

Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey

OBJECTIVE

Congestive heart failure (CHF) has been associated with insulin resistance, but few studies have examined its relationship with metabolic syndrome (MetS). Little is known about whether insulin resistance explains the association between MetS and CHF.

DESIGN

Population-based, cross-sectional surveys.

SETTING

Third National Health and Nutrition Examination Survey (NHANES III).

PARTICIPANTS

Data from 5549 men and non-pregnant women aged > or =40 years in NHANES III were analysed.

RESULTS

About 4% of men and 3% of women had CHF between 1988 and 1994 in the US. The age-adjusted prevalence of CHF was significantly higher in African Americans (4.1%), in Mexican Americans (8.5%) and in those of other ethnic origin (6.7%) than in white people (2.5%). People with MetS had nearly twice the likelihood of self-reported CHF (adjusted odds ratio 1.8; 95% confidence interval 1.1 to 3.0) after adjustment for demographic and conventional risk factors such as sex, ethnicity, age, smoking, total cholesterol, left ventricular hypertrophy, and probable or possible myocardial infarction determined by electrocardiography. However, this association was attenuated after further adjustment for insulin resistance as measured by the homoeostasis model assessment (HOMA). >90% of the association between MetS and CHF was explained by the HOMA.

CONCLUSIONS

MetS was associated with about a twofold increased likelihood of self-reported CHF and it may serve as a surrogate indicator for the association between insulin resistance and CHF.

Association of C-reactive protein with surrogate measures of insulin resistance among nondiabetic US from National Health and Nutrition Examination Survey 1999-2002

BACKGROUND

Increased C-reactive protein (CRP) concentration and insulin resistance (IR) are associated with increased rates of adverse cardiovascular events. We sought to examine the relationship of CRP with surrogate measures of IR among nondiabetic adults in the US.

METHODS

We conducted analyses using data from the National Health and Nutrition Examination Survey 1999-2002. We analyzed a nationally representative sample of 2514 men and nonpregnant women age > or = 20 years who were non-Hispanic white, non-Hispanic black, or Mexican American.

RESULTS

After adjustment for age, sex, race/ethnicity, smoking status, systolic blood pressure, and serum concentrations of HDL cholesterol, LDL cholesterol, and triglyceride, CRP was significantly associated with 10 IR measures (all P values <0.01). The strength of the association attenuated after further adjustment for waist circumference (change in adjusted regression coefficients ranging from 60.0% to 75.1%). The association of CRP with each IR surrogate was similar (standardized regression coefficient ranges from 0.06 to 0.09). The association of CRP (>3 vs <1 mg/L) with the homeostasis model for assessment of IR (> or = 75th vs <75th percentile) was statistically significant among people with a body mass index > or = 30 kg/m(2) (odds ratio, 2.6; 95% CI, 1.3-5.1) or with a body mass index <25 kg/m(2) (odds ratio, 2.5; 95% CI, 1.5-4.2).

CONCLUSIONS

CRP was significantly associated with the surrogate measures of IR among nondiabetic adults. Obesity may play an important role in the association of CRP with IR in this nationally representative sample.

Modifiable characteristics of a healthy lifestyle in U.S. older adults with or without frequent mental distress: 2003 Behavioral Risk Factor Surveillance System

OBJECTIVE

To examine the associations between frequent mental distress (FMD; 14 or more mentally unhealthy days during the previous 30 days), health behaviors, body weight, and use of preventive services among adults >or=65 years using the 2003 Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Participants (N = 52,600) were asked how many days during the past 30 days that their mental health was not good. Having a healthy weight (body mass index 18.5-24.9 kg/m(2)), not smoking, consuming <or=1 alcoholic beverage per day, consuming of at least five fruits or vegetables daily, participating in moderate-to-vigorous physical activity during the average week, receiving an annual influenza immunization, and ever receiving a pneumococcal immunization were examined in addition to combinations of these behaviors.

RESULTS

People with FMD were less likely than those without FMD to be nonsmokers (adjusted odds ratio [AOR] = 0.67, confidence interval [CI] = 0.53-0.85), to consume at least five fruits or vegetables daily (AOR = 0.80, CI = 0.70-0.91), and to participate in moderate-to-vigorous physical activity during the average week (AOR = 0.82, CI = 0.68-0.99). However, there was no difference between those with and without FMD in the consumption of <or=1 alcoholic beverage per day, having a healthy weight, receiving an annual influenza immunization, and ever receiving a pneumococcal immunization.

CONCLUSIONS

Older adults with FMD are less likely to engage in many health behaviors and to use preventive services than those without FMD.

Socioeconomic position and the metabolic syndrome in early, middle, and late life: evidence from NHANES 1999-2002

PURPOSE

To evaluate whether there is an association between socioeconomic position (SEP) and the metabolic syndrome at various ages, including adolescent, middle-aged and older participants in gender-specific analyses.

METHODS

Participants were from the 1999-2002 National Health and Nutrition Examination Survey. SEP was measured by income and years of education. Metabolic syndrome was measured in adults using the American Heart Association guidelines and in adolescents using methods based on national reference data. Cross-sectional multivariable-adjusted logistic regression analyses were performed.

RESULTS

In women aged 25 to 45 and 46 to 65 years, income below the poverty line (poverty income ratio [PIR] less than one) was associated with higher odds of metabolic syndrome compared with PIR greater than 3 (odds ratio [OR] = 4.90; 95% confidence interval (CI) = 2.24, 10.71, and OR = 2.54; CI = 1.38, 4.67, for the respective age groups) after adjustment for age, race/ethnicity, and menopause. Similar findings were observed for educational attainment. In adolescents, older adults (aged >65 years), and males, income and education were not related to the metabolic syndrome.

CONCLUSIONS

This report demonstrates that SEP is associated with the metabolic syndrome in females aged 25 to 65 years and is less strongly associated in males, adolescents, or older participants. These findings provide physiologic mechanistic evidence linking SEP to risk for coronary heart disease.

Completion of a Durable Power of Attorney for Health Care: What Does Cognition Have to Do With It?

PURPOSE

This study examined the association between cognitive functioning and completion of a durable power of attorney for health care.

DESIGN AND METHODS

Participants were from the Second Longitudinal Study on Aging (LSOA II), a nationally representative sample of community-dwelling persons who were at least 70 years of age at the time of participation. The sample included 325 older adult respondents (144 men, 181 women) with a mean age of 80.7 years (SE = 0.36) and a mean educational attainment of 11.6 years (SE = 0.18). Researchers measured each respondent's cognitive functioning during follow-up by using an adapted Telephone Interview of Cognitive Status, and a proxy informant indicated whether the respondent completed a durable power of attorney for health care.

RESULTS

A durable power of attorney for health care was completed by 60.8% (SE = 2.51) of respondents prior to their death. Logistic regression demonstrated that respondents with the first quartile of global cognitive functioning were 76% less likely to have completed a durable power of attorney (adjusted odds ratio = 0.24, 95% confidence interval = 0.09-0.60) than those with the fourth quartile of cognitive functioning.

IMPLICATIONS

The factors associated with completion of durable power of attorney for health care by older adults with lower levels of cognitive functioning should be investigated further. Such data could be used to inform interventions to increase the completion rates of durable power of attorney for health care among this particular group of older adults.

Clustering of multiple healthy lifestyle habits and health-related quality of life among U.S. adults with diabetes

OBJECTIVE

We sought to examine the association between clustering of multiple healthy lifestyle habits (HLHs) and health-related quality of life (HRQOL) among adults with diabetes.

RESEARCH DESIGN AND METHODS

We analyzed the representative sample of the civilian, noninstitutionalized U.S. population aged > or = 18 years with diabetes using data from the 2005 Behavioral Risk Factor Surveillance System (n = 16,428). Four HRQOL measures were general health rating, physically unhealthy days, mentally unhealthy days, and impaired activity days. Three HLHs included not smoking, engaging in adequate leisure time physical activity, and consuming five or more servings of fruits and vegetables per day.

RESULTS

The proportion of having 0, 1, 2, and 3 HLHs was 10.5, 44.7, 32.9, and 11.9%, respectively. The age-adjusted prevalence rates of poor or fair health, > or = 14 physically unhealthy days, > or = 14 mentally unhealthy days, and > or = 14 impaired activity days were 43.07, 27.61, 17.22, and 18.87%, respectively. After adjustment for potential confounders and comparison with none of the three HLHs, people with all three HLHs were less likely to report poor or fair health (adjusted odds ratio 0.49 [95% CI 0.33-0.71]), > or = 14 physically unhealthy days (0.56 [0.39-0.80]), > or = 14 mentally unhealthy days (0.35 [0.23-0.55]), or > or = 14 impaired activity days (0.35 [0.23-0.56]).

CONCLUSIONS

Accumulation of multiple HLHs was significantly associated with better HRQOL among people with diabetes.

Explaining the decrease in U.S. deaths from coronary disease, 1980-2000

BACKGROUND

Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors.

METHODS

We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses.

RESULTS

From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively).

CONCLUSIONS

Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.

Is there a single underlying factor for the metabolic syndrome in adolescents? A confirmatory factor analysis

OBJECTIVE

The lack of a universally applicable model for the metabolic syndrome in the pediatric population makes it difficult to define this syndrome and compare its prevalence across studies and diverse populations. We sought to assess whether a single underlying factor could represent the metabolic syndrome in adolescents.

RESEARCH DESIGN AND METHODS

Using data from the National Health and Nutrition Examination Survey (1999-2002), we conducted a confirmatory factor analysis to assess the validity of waist circumference, triglycerides, fasting insulin, and systolic blood pressure (SBP) as potential phenotypic traits for the metabolic syndrome in adolescents aged 12-17 years (n = 1,262). A multiple-group approach was used to test the invariance in factor loadings across sex and race/ethnicity.

RESULTS

The estimates of factor loadings for the total sample were 0.76, 0.46, 0.81, and 0.42 for waist circumference, triglycerides, fasting insulin, and SBP, respectively. The goodness-of-fit indexes were adequate for the total sample (comparative fit index, 0.99; standardized root mean square residual, 0.02), Caucasian boys (1.0; 0.01), African-American boys (0.99; 0.03), Mexican-American boys (1.0; 0.01), Mexican-American girls (1.0; 0.01), and Caucasian girls (0.95; 0.04) and acceptable for African-American girls (0.94; 0.05). There were no significant differences in factor loadings of the four measured variables between boys and girls and among the three racial or ethnic subgroups.

CONCLUSIONS

The metabolic syndrome as a single underlying factor for the four simple phenotypic traits may be plausible in adolescents. The proposed model appears to be generalizable across sex and race/ethnicity.

Intake of dietary magnesium and the prevalence of the metabolic syndrome among U.S. adults

OBJECTIVE

Limited data suggest that people with the metabolic syndrome have lower intakes or circulating concentrations of magnesium than those who do not have the syndrome. The aim of this study was to examine the associations between dietary intake of magnesium and the prevalence of the metabolic syndrome in a nationally representative sample of U.S. adults.

RESEARCH METHODS AND PROCEDURES

We used data for 7669 participants > or =20 years of age of the Third National Health and Nutrition Examination Survey (1988 to 1994). The metabolic syndrome was defined using the criteria of the National Cholesterol Education Program. Magnesium intake was determined from a single dietary 24-hour recall.

RESULTS

The unadjusted prevalences of the metabolic syndrome were 29.0% (quintile of lowest magnesium intake), 27.5%, 25.8%, 23.9%, and 21.8% for increasing quintiles of magnesium intake (p for trend = 0.002). After multiple adjustment, the odds ratios for the second through the fifth quintiles (highest intake) of magnesium intake among all participants included in the analysis were 0.84 [95% confidence interval (CI): 0.58, 1.23], 0.76 (95% CI: 0.54, 1.07), 0.62 (95% CI: 0.40, 0.98), and 0.56 (95% CI: 0.34, 0.92), respectively (p for trend = 0.029). The associations were similar for men and women.

DISCUSSION

Our results showing an inverse association between dietary magnesium intake and the prevalence of the metabolic syndrome add to the evidence that adequate magnesium intake or a diet rich in magnesium may be important for maintaining good cardiometabolic health.

Prevalence of the metabolic syndrome in individuals with hyperuricemia

PURPOSE

The link between hyperuricemia and insulin resistance has been noted, but the prevalence of the metabolic syndrome by recent definitions among individuals with hyperuricemia remains unclear. Our objective was to determine the prevalence of the metabolic syndrome according to serum uric acid levels in a nationally representative sample of US adults.

METHODS

By using data from 8669 participants aged 20 years and more in The Third National Health and Nutrition Examination Survey (1988-1994), we determined the prevalence of the metabolic syndrome at different serum uric acid levels. We used both the revised and original National Cholesterol Education Program Adult Treatment Panel (NCEP/ATP) III criteria to define the metabolic syndrome.

RESULTS

The prevalences of the metabolic syndrome according to the revised NCEP/ATP III criteria were 18.9% (95% confidence interval [CI], 16.8-21.0) for uric acid levels less than 6 mg/dL, 36.0% (95% CI, 32.5-39.6) for uric acid levels from 6 to 6.9 mg/dL, 40.8% (95% CI, 35.3-46.4) for uric acid levels from 7 to 7.9 mg/dL, 59.7% (95% CI, 53.0-66.4) for uric acid levels from 8 to 8.9 mg/dL, 62.0% (95% CI, 53.0-66.4) for uric acid levels from 9 to 9.9 mg/dL, and 70.7% for uric acid levels of 10 mg/dL or greater. The increasing trends persisted in subgroups stratified by sex, age group, alcohol intake, body mass index, hypertension, and diabetes. For example, among individuals with normal body mass index (<25 kg/m2), the prevalence increased from 5.9% (95% CI, 4.8-7.0), for a uric acid level of less than 6 mg/dL, to 59.0%, (95% CI, 20.1-97.9) for a uric acid level of 10 mg/dL or greater. With the original NCEP/ATP criteria, the corresponding prevalences were slightly lower.

CONCLUSIONS

These findings from a nationally representative sample of US adults indicate that the prevalence of the metabolic syndrome increases substantially with increasing levels of serum uric acid. Physicians should recognize the metabolic syndrome as a frequent comorbidity of hyperuricemia and treat it to prevent serious complications.

Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents

BACKGROUND

The association between concentrations of uric acid and the metabolic syndrome in children and adolescents remains incompletely understood. The objective of this study was to examine how these 2 were associated in a nationally representative sample of US children and adolescents.

METHODS AND RESULTS

We performed a cross-sectional analysis of 1370 males and females aged 12 to 17 years using data from the National Health and Nutrition Examination Survey 1999-2002. The prevalence of the metabolic syndrome was < 1% among participants in the lowest quartile of serum concentration of uric acid, 3.7% in the second quartile, 10.3% in the third quartile, and 21.1% in the highest quartile. Compared with the lowest 2 quartiles of uric acid together (< or = 291.5 micromol/L), the odds ratios were 5.80 (95% confidence interval, 3.22 to 10.46) for those in the third quartile (> 291.5 to < or = 339 micromol/L or > 4.9 to < or = 5.7 mg/dL) and 14.79 (95% confidence interval, 7.78 to 28.11) for those in the top quartile (> 339 micromol/L) after adjustment for age, sex, race or ethnicity, and concentrations of C-reactive protein. Starting with the lowest quartile of concentration of uric acid, mean concentrations of serum insulin were 66.2, 66.7, 79.9, and 90.9 pmol/L for ascending quartiles, respectively (P for trend <0.001).

CONCLUSIONS

Among US children and adolescents, serum concentrations of uric acid are strongly associated with the prevalence of the metabolic syndrome and several of its components.

Ethnicity and Nutrient Intake among Arizona WISEWOMAN Participants

BACKGROUND

Diet quality and risks of chronic disease have been identified, yet nutrient intakes from older uninsured populations have been scarcely described.

METHODS

Using the dietary intake profiles of an older, uninsured, and mostly Hispanic sample of Arizona WISEWOMAN participants, two ethnic groups were compared: Mexican American and non-Hispanic white women. Sociodemographic data related to nutrient intakes were identified. Estimated mean nutrient intakes of Mexican Americans (n = 260) and non-Hispanic white (n = 88) women were compared based on ethnicity and acculturation levels. Using linear regression models, associations of individual characteristics were made on nutrients for which reported intakes were less than the estimated average requirement (EAR).

RESULTS

Mexican Americans had energy, vitamin E, and niacin intakes that were significantly lower than those of non-Hispanic whites, whereas vitamin A intake was significantly higher among Mexican Americans. Less acculturated Mexican American women had significantly higher intakes of vitamin E and folate than their more acculturated counterparts. For both ethnic and acculturation groups, intakes of vitamin E, calcium, and potassium were lower than the established standards in more than 70% of this population. Having a high body mass index (BMI) was associated with lower reported energy intake and higher protein and potassium intakes, and smoking was associated with lower intakes of vitamin E and folate.

CONCLUSIONS

Mexican American women had overall lower micronutrient intakes compared with uninsured non-Hispanic white older women; this difference may be attributed to their underreporting intake.

Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey

OBJECTIVE

To determine the prevalence of metabolic syndrome among patients with gout and to examine the association between the 2 conditions in a nationally representative sample of US adults.

METHODS

Using data from 8,807 participants age >or=20 years in the Third National Health and Nutrition Examination Survey (1988-1994), we determined the prevalence of metabolic syndrome among individuals with gout and quantified the magnitude of association between the 2 conditions. We used both the revised and original National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria to define metabolic syndrome.

RESULTS

The prevalence (95% confidence interval [95% CI]) of metabolic syndrome according to revised NCEP/ATP III criteria was 62.8% (51.9-73.6) among individuals with gout and 25.4% (23.5-27.3) among individuals without gout. Using 2002 census data, approximately 3.5 million US adults with a history of gout have metabolic syndrome. The unadjusted and age- and sex-adjusted odds ratios (95% CI) of metabolic syndrome for individuals with gout were 4.96 (3.17-7.75) and 3.05 (2.01-4.61), respectively. With the original NCEP/ATP criteria, the corresponding prevalences were slightly lower, whereas the corresponding odds ratios were slightly higher. The stratified prevalences of metabolic syndrome by major associated factors of gout (i.e., body mass index, hypertension, and diabetes) remained substantially and significantly higher among those with gout than those without gout (all P values <0.05).

CONCLUSION

These findings indicate that the prevalence of metabolic syndrome is remarkably high among individuals with gout. Given the serious complications associated with metabolic syndrome, this frequent comorbidity should be recognized and taken into account in long-term treatment and overall health of individuals with gout.

Associations between concentrations of α- and γ-tocopherol and concentrations of glucose, glycosylated haemoglobin, insulin and C-peptide among US adults

Our objective was to study the cross-sectional associations between concentrations of α- and γ-tocopherol and concentrations of glucose, glycosylated haemoglobin, insulin and C-peptide among US adults. We used data for 1289 participants without self-reported diabetes who were aged ≥20 years in the National Health and Nutrition Examination Survey 1999–2000. α-Tocopherol concentration was inversely associated with glucose concentration (β per mmol/l=−0·01064, se 0·00356, P=0·004) after adjusting for age, sex, race or ethnicity, education, smoking status, concentrations of total cholesterol and triacylglycerols, systolic blood pressure, waist circumference, alcohol use, physical activity, time watching television or videos or using a computer, and use of vitamin/mineral/dietary supplements. Among 659 participants who did not report using supplements, this association was no longer significant whereas the concentration of α-tocopherol was inversely associated with concentration of C-peptide (β per mmol/l=−0·01121, se 0·00497, P=0·024). γ-Tocopherol concentration was positively associated with concentration of glucose (β per mmol/l=0·09169, se 0·02711, P=0·001) and glycosylated haemoglobin (β per mmol/l=0·04954, se 0·01284, P<0·001), but not insulin or C-peptide. The relationships between physiologic concentrations of the various forms of vitamin E and measures of glucose intolerance deserve additional investigation.

Natural disasters and older US adults with disabilities: implications for evacuation

We analysed 2003 and 2004 Behavioral Risk Factor Surveillance System (BRFSS) data from New Orleans-Metairie-Kenner, LA to produce estimates of the number of community dwelling people aged 65 years or older with a disability and requiring special equipment.(4) Approximately, 47,840 (31.6 per cent) older adults with a disability and 24,938 (16.6 per cent) older adults requiring the use of special equipment were community dwelling and might require assistance to evacuate or a shelter that could accommodate special equipment. Older adults who need special equipment were likely to be female, unmarried and white, and to rate their health as fair or poor. Personnel who plan and prepare for evacuations and temporary shelter during disasters need baseline information on the number of older adults with a disability or who require special equipment. A surveillance system, such as the BRFSS, gathers information that planners can use to prepare for and to deliver services.

Physical activity or fitness and the metabolic syndrome

The metabolic syndrome is highly prevalent in populations around the world, regardless of the definition used. Physical inactivity and obesity are two of the major modifiable risk factors for the metabolic syndrome. Cross-sectional and prospective studies have generally found that levels of physical activity and fitness are inversely related to the prevalence of this syndrome. More recent research has also suggested that sedentary behaviors, such as excessive time spent watching television or using a computer, are significantly associated with an increased risk for this syndrome. Separate but complementary approaches that encourage increased participation in physical activity and discourage sedentary behaviors, both at the individual and population level, may prove useful in reducing the prevalence of this syndrome.

Intake and circulating concentrations of antioxidants in metabolic syndrome

Metabolic syndrome, which occurs commonly in populations around the world, has been associated with an increased risk for developing cardiovascular disease and diabetes. Oxidative stress, which has been implicated in the pathogenesis of cardiovascular disease and diabetes, is a common feature of metabolic syndrome. Limited evidence suggests that circulating concentrations of antioxidants are decreased among people with metabolic syndrome. The contributions of reduced consumption and increased utilization of antioxidants leading to increased oxidative stress are largely unknown. People with metabolic syndrome appear to be an attractive group for future research about possible therapeutic options of antioxidants in the medical management of this syndrome.

Acculturation, weight, and weight-related behaviors among Mexican Americans in the United States

OBJECTIVE

This analysis explores the association between acculturation and body weight, self-perceptions of weight, and attempt to lose weight among Mexican Americans.

METHODS

Data were analyzed from the National Health and Nutrition Examination Survey (NHANES) for 2001-2002. Indicator of acculturation used was language assimilation. Factor analysis was used to construct the acculturation measure, and descriptive and multivariable analyses were conducted using SUDAAN.

RESULTS

The acculturation measure differentiated body weight, weight-related behavior, and self-perceptions about weight. Those lower on the acculturation scale were less likely to have a high BMI (> or =30) (24% vs 32%), and their perceptions of their own weight, desired weight, and recent history of trying to lose weight differed significantly from those persons high on the acculturation scale and these varied by sex. Among Mexican Americans with a BMI > or =25, those lower on the acculturation measure were significantly less likely to perceive themselves as overweight (60% vs 73%). They were also less likely to have attempted to lose weight in the past year than those who were high on the acculturation measure (OR = 0.49; 95% CI: 0.31-0.79).

CONCLUSIONS

Less acculturated Mexican Americans with BMI > or =25 were less likely to perceive themselves as overweight and to have tried to lose weight. The acculturation measure provides insights into Mexican Americans' perceptions of their own weight and their recent attempt of trying to lose weight.