BACKGROUND: Depression is a common mental health disorder. OBJECTIVE: The objective of this study was to explore the association between diet quality, as measured by the Healthy Eating Index (HEI-2020), and depression symptoms among US adolescents and young adults, 12-29 years. DESIGN: The study design was a cross sectional secondary data analysis. PARTICIPANTS: Data from the first 24-hour dietary recall for adolescents and young adults 12-29 years in the National Health and Nutrition Examination Survey 2015-March 2020 (n=4750) were analyzed. MAIN OUTCOME: Depression was defined as a score ≥10 from the Patient Health Questionnaire reflecting moderate or severe symptoms in the previous 2 weeks. STATISTICAL ANALYSES PERFORMED: HEI-2020 total (range 0-100) and component scores were calculated for those with and without depression. Predicted HEI-2020 scores were estimated from linear regression models, adjusting for age, gender, race and Hispanic origin, family income, and seeing a mental health professional in the past year. Statistical analyses accounted for the complex sample design. RESULTS: The prevalence of depression among adolescents and young adults was 7.8% (95% confidence interval (CI) 6.3-9.5%). Total HEI-2020 score was 45.9 (95% CI 45.0-46.7) out of 100 on a given day during 2015-March 2020. Among young people with depression, total HEI-2020 score was lower than among those without depression (41.7 versus 46.2, p<0.001). After adjustment for covariates, the difference was attenuated but remained significant. In adjusted analyses, HEI-2020 component scores were lower for those with depression compared to those without depression for the adequacy components: Total Fruits (1.4 vs. 1.7 p=0.03), Whole Fruits (1.2 vs. 1.7 p<0.01), Total Vegetables (2.1 vs. 2.6 p<0.01), Greens and Beans (0.8 vs. 1.2 p<0.01), and Total Protein foods (3.6 vs. 4.0 p=0.02) out of maximum scores of 5. There were no statistically significant differences observed for Whole Grains, Dairy, Seafood and Plant Proteins, Fatty Acids, Saturated Fats, Refined Grains, Sodium, or Added Sugars. CONCLUSION: Overall diet quality is low among young people. Diet quality, especially consumption of fruits, vegetables, and protein foods was lower among young people with depression compared to those without depression.

INTRODUCTION: The risk of diabetes begins at a lower BMI among Asian adults. This study compares the prevalence of diabetes between the U.S. and China by BMI. METHODS: Data from the 2015-2017 China Nutrition and Health Surveillance (n=176,223) and the 2015-2018 U.S. National Health and Nutrition Examination Survey (n=4,464) were used. Diagnosed diabetes was self-reported. Undiagnosed diabetes was no report of diagnosed diabetes and fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%. Predicted age-adjusted prevalence estimates by BMI were produced using sex- and country-specific logistic regression models. RESULTS: In China, the age-adjusted prevalence of total diabetes was 7.8% (95% CI=7.4%, 8.3%), lower than the 14.6% (95% CI=13.1%, 16.3%) in the U.S. The prevalence of diagnosed diabetes was also lower in China than in the U.S. There were no statistically significant differences in the prevalence of undiagnosed diabetes between China and the U.S. The distribution of BMI in China was lower than in the U.S., and the predicted prevalence of total diabetes was similar between China and the U.S. when comparing adults with the same BMI. The predicted prevalence of undiagnosed diabetes was higher in China than in the U.S. for both men and women, and this disparity increased with BMI. When comparing adults at the same BMI, there was little difference in the prevalence of total diabetes, but diagnosed diabetes was lower in China than in the U.S., and undiagnosed was higher. CONCLUSIONS: Although differences in BMI appear to explain nearly all of the differences in total diabetes prevalence in the 2 countries, not all factors that are associated with diabetes risk have been investigated.

This cross-sectional study evaluates reasons reported for not participating in or withdrawing participation from the Special Supplemental Nutrition Program for Women, Infants, and Children from 2019 to March 2020. | eng

Health equity is defined as “attainment of the highest level of health for all people” and encompasses fair and just opportunities for everyone to be as healthy as possible.1 Health equity research examines the existence of health disparities and their underlying factors, which can be categorized into broad determinants of health, including genetics, behavior, environmental influences, medical care, and social factors.2 The last category, also known as social determinants of health (SDOH), includes social and structural factors, such as racism and discriminatory practices and policies.3 Healthy People 2030 categorizes SDOH into five domains4: education access and quality, economic stability, health care access and quality, social and community context, and neighborhood and built environment. Evidence shows that SDOH influence a wide range of health outcomes5,6 and nutritional status.7 Exposures to adverse SDOH, such as food deserts and unsafe neighborhoods, are inequitably experienced by subgroups that vary by race and ethnicity, socioeconomic status, and other characteristics historically associated with discrimination or exclusion. Variation among groups in access to resources and their differential vulnerability to adverse exposures result in health disparities.8

BACKGROUND: Limited information is available on added sugars consumption in US infants and toddlers. OBJECTIVES: To present national estimates of added sugars intake among US infants and toddlers by sociodemographic characteristics, to identify top sources of added sugars, and to examine trends in added sugars intake. DESIGN: Cross-sectional analysis of 1 day of 24-hour dietary recall data. PARTICIPANTS/SETTING: A nationally representative sample of US infants aged 0 to 11 months and toddlers aged 12 to 23 months (n=1,211) during the period from 2011 through 2016 from the National Health and Nutrition Examination Survey. Trends were assessed from 2005-2006 through 2015-2016 (n=2,795). MAIN OUTCOME MEASURES: Among infants and toddlers, the proportion consuming any added sugars, the average amount of added sugars consumed, percent of total energy from added sugars, and top sources of added sugars intake. STATISTICAL ANALYSIS: Paired t tests were used to compare differences by age, sex, race/Hispanic origin, family income level, and head of household education level. Trends were tested using orthogonal polynomials. Significance was set at P<0.05. RESULTS: During 2011 to 2016, 84.4% of infants and toddlers consumed added sugars on a given day. A greater proportion of toddlers (98.3%) consumed added sugars than infants (60.6%). The mean amount of added sugars toddlers consumed was also more compared with infants (5.8 vs 0.9 tsp). Non-Hispanic black toddlers (8.2 tsp) consumed more added sugars than non-Hispanic Asian (3.7 tsp), non-Hispanic white (5.3 tsp), and Hispanic (5.9 tsp) toddlers. A similar pattern was observed for percent energy from added sugars. For infants, top sources of added sugars were yogurt, baby food snacks/sweets, and sweet bakery products; top sources among toddlers were fruit drinks, sugars/sweets, and sweet bakery products. The mean amount of added sugars decreased from 2005-2006 through 2015-2016 for both age groups; however, percent energy from added sugars only decreased among infants. CONCLUSION: Added sugars intake was observed among infants/toddlers and varied by age and race and Hispanic origin. Added sugars intake, as a percent of energy, decreased only among infants from 2005 to 2016.

BACKGROUND: In 2009, the US Department of Agriculture Food and Nutrition Service's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages were revised to include more whole fruits, vegetables, whole grains, and lower-fat milk. OBJECTIVE: To describe trends over time in the consumption of fruits (total and whole), vegetables, whole grains, milk (whole, reduced fat, low-fat or nonfat (LFNF), and flavored), and added sugars, including breakfast cereals, by WIC participation status (current WIC recipient, WIC income-eligible nonrecipient, and WIC income-ineligible nonrecipient). METHODS: Dietary intakes on a given day for 1- to 4-y-old children (n = 5568) from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed to examine trends in the percentage of individuals consuming and amounts consumed over time using linear regression adjusted for age, sex, and race and Hispanic origin. RESULTS: From 2005 through 2018, the percentage of WIC recipients or WIC income-eligible nonrecipients consuming fruits and vegetables on a given day did not change, but the percentage of fruit consumed as whole fruit increased significantly among WIC recipients (36.4%-62.1%), but not among income-eligible nonrecipients. Among the WIC recipients, the percentage of consumption (5.5%-29.3%), the amount of LFNF milk servings consumed (0.1-0.4 cups), and the percentage of the total milk consumed as LFNF milk (4.8%-27%) significantly increased from 2005 to 2018. Conversely, the percentage of energy (12.3%-10.8%) and servings (11.4-10.6 teaspoons) from added sugars declined significantly. Among WIC-eligible nonrecipients, the servings of whole grains increased significantly, whereas servings and percentage of energy from added sugars declined significantly. CONCLUSIONS: From 2005 through 2018, changes in dietary patterns for WIC recipients did not always mirror those of US children of the same age. The percentage of fruit consumed as whole fruit, and the percentage and quantity of milk consumed as LFNF milk increased significantly among WIC recipients, but not among income-eligible nonrecipients. J Nutr 20XX;xx:xx-xx.

This study uses NHANES data to assess trends in obesity and severe obesity stratified by race and Hispanic origin among US residents from 1999 to 2018.

Differences by nativity status for cardiovascular disease (CVD) risk factors have been previously reported. Recent research has focused on understanding how other acculturation factors, such as length of residence, affect health behaviors and outcomes. This study examines the association between CVD risk factors and nativity/length of US residence. Using cross-sectional data from 15,965 adults in the 2011-2016 National Health and Nutrition Examination Surveys (analyzed in 2018), prevalence ratios and predicted marginals from logistic regression models are used to estimate associations of CVD risk factors (i.e., hypertension, hypercholesterolemia, diabetes, overweight/obesity and smoking) with nativity/length of residence (<15years, >/=15years) in the US. In sex-, age-, education- and race and Hispanic origin- adjusted analyses, a higher percentage of US (50 states and District of Columbia) born adults (86.4%) had >/=1 CVD risk factor compared to non-US born residents in the US <15years (80.1%) but not >/=15years (85.1%). Compared to US born counterparts, regardless of length of residence, hypertension overall and smoking among non-Hispanic white and Hispanic adults were lower among non-US born residents. Overweight/obesity overall and diabetes among Hispanic adults were lower among non-US born residents in the US <15years. In contrast, non-US born non-Hispanic Asian residents in the US <15years had higher prevalence of diabetes. Non-US born adults were less likely to have most CVD risk factors compared to US born adults regardless of length of residence, although, for smoking and diabetes this pattern differed by race and Hispanic origin.

Active transportation (AT), or walking or bicycling for transportation, represents one way individuals can achieve recommended physical activity (PA) levels. This study describes AT prevalence and temporal trends, and examines associations between AT levels and measured CVD risk factors (hypertension, hypercholesterolemia, low high-density [HDL] cholesterol, diabetes, and obesity) among U.S. adults. National Health and Nutrition Examination Survey (NHANES) 2007-2016 data (analyzed in 2017) were used to conduct overall trend analyses of reported AT in a typical week [none (0-9min/week); low (10-149min/week); or high (>/=150min/week)]. Logistic regression was used to examine associations between AT level and each CVD risk factor from NHANES 2011-2016 (n=13,943). Covariates included age, sex, race/Hispanic origin, education, income, smoking, survey cycle, non-transportation PA, and urbanization level. U.S. adults who engaged in high AT levels increased from 13.1% in 2007-2008 to 17.9% in 2011-2012, and then decreased to 10.6% in 2015-2016 (p for quadratic trend=0.004). Over the same period, the quadratic trend for low AT was not significant. During 2011-2016, 14.3% of adults engaged in high AT, 11.4% in low AT, and 74.4% in no AT. High AT levels were associated with decreased odds of each CVD risk factor assessed, compared to no AT. Low AT (versus no AT) was associated with decreased odds of hypertension (aOR=0.77, 95% CI 0.64, 0.91) and diabetes (aOR=0.68, 95% CI 0.54, 0.85). AT prevalence among adults has fluctuated from 2007 to 2016. Despite favorable associations between AT and CVD risk factors, most U.S. adults do not engage in any AT.

Importance: Differences in obesity by sex, age group, race and Hispanic origin among US adults have been reported, but differences by urbanization level have been less studied. Objectives: To provide estimates of obesity by demographic characteristics and urbanization level and to examine trends in obesity prevalence by urbanization level. Design, Setting, and Participants: Serial cross-sectional analysis of measured height and weight among adults aged 20 years or older in the 2001-2016 National Health and Nutrition Examination Survey, a nationally representative survey of the civilian, noninstitutionalized US population. Exposures: Sex, age group, race and Hispanic origin, education level, smoking status, and urbanization level as assessed by metropolitan statistical areas (MSAs; large: >/=1 million population). Main Outcomes and Measures: Prevalence of obesity (body mass index [BMI] >/=30) and severe obesity (BMI >/=40) by subgroups in 2013-2016 and trends by urbanization level between 2001-2004 and 2013-2016. Results: Complete data on weight, height, and urbanization level were available for 10792 adults (mean age, 48 years; 51% female [weighted]). During 2013-2016, 38.9% (95% CI, 37.0% to 40.7%) of US adults had obesity and 7.6% (95% CI, 6.8% to 8.6%) had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs (42.4% vs 31.8%, respectively; adjusted difference, 9.8 percentage points [95% CI, 5.1 to 14.5 percentage points]); however, the age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs (38.9% vs 31.8%, respectively; adjusted difference, 4.8 percentage points [95% CI, -2.9 to 12.6 percentage points]). The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs (42.5% vs 38.1%, respectively; adjusted difference, 4.3 percentage points [95% CI, 0.2 to 8.5 percentage points]) and among women living in non-MSAs compared with women living in large MSAs (47.2% vs 38.1%, respectively; adjusted difference, 4.7 percentage points [95% CI, 0.2 to 9.3 percentage points]). Similar patterns were seen for severe obesity except that the difference between men living in large MSAs compared with non-MSAs was significant. The age-adjusted prevalence of obesity and severe obesity also varied significantly by age group, race and Hispanic origin, and education level, and these patterns of variation were often different by sex. Between 2001-2004 and 2013-2016, the age-adjusted prevalence of obesity and severe obesity significantly increased among all adults at all urbanization levels. Conclusions and Relevance: In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity and severe obesity in 2013-2016 varied by level of urbanization, with significantly greater prevalence of obesity and severe obesity among adults living in nonmetropolitan statistical areas compared with adults living in large metropolitan statistical areas.

Importance: Differences in childhood obesity by demographics and urbanization have been reported. Objective: To present data on obesity and severe obesity among US youth by demographics and urbanization and to investigate trends by urbanization. Design, Setting, and Participants: Measured weight and height among youth aged 2 to 19 years in the 2001-2016 National Health and Nutrition Examination Surveys, which are serial, cross-sectional, nationally representative surveys of the civilian, noninstitutionalized population. Exposures: Sex, age, race and Hispanic origin, education of household head, and urbanization, as assessed by metropolitan statistical areas (MSAs; large: >/= 1 million population). Main Outcomes and Measures: Prevalence of obesity (body mass index [BMI] >/=95th percentile of US Centers for Disease Control and Prevention [CDC] growth charts) and severe obesity (BMI >/=120% of 95th percentile) by subgroups in 2013-2016 and trends by urbanization between 2001-2004 and 2013-2016. Results: Complete data on weight, height, and urbanization were available for 6863 children and adolescents (mean age, 11 years; female, 49%). In 2013-2016, the prevalence among youth aged 2 to 19 years was 17.8% (95% CI, 16.1%-19.6%) for obesity and 5.8% (95% CI, 4.8%-6.9%) for severe obesity. Prevalence of obesity in large MSAs (17.1% [95% CI, 14.9%-19.5%]), medium or small MSAs (17.2% [95% CI, 14.5%-20.2%]) and non-MSAs (21.7% [95% CI, 16.1%-28.1%]) were not significantly different from each other (range of pairwise comparisons P = .09-.96). Severe obesity was significantly higher in non-MSAs (9.4% [95% CI, 5.7%-14.4%]) compared with large MSAs (5.1% [95% CI, 4.1%-6.2%]; P = .02). In adjusted analyses, obesity and severe obesity significantly increased with greater age and lower education of household head, and severe obesity increased with lower level of urbanization. Compared with non-Hispanic white youth, obesity and severe obesity prevalence were significantly higher among non-Hispanic black and Hispanic youth. Severe obesity, but not obesity, was significantly lower among non-Hispanic Asian youth than among non-Hispanic white youth. There were no significant linear or quadratic trends in obesity or severe obesity prevalence from 2001-2004 to 2013-2016 for any urbanization category (P range = .07-.83). Conclusions and Relevance: In 2013-2016, there were differences in the prevalence of obesity and severe obesity by age, race and Hispanic origin, and household education, and severe obesity was inversely associated with urbanization. Demographics were not related to the urbanization findings.

This study uses National Health and Nutrition Examination Survey data to characterize trends in obesity prevalence among US youth and adults between 2007-2008 and 2015-2016.

Obesity prevalence varies by income and education level, although patterns might differ among adults and youths (1-3). Previous analyses of national data showed that the prevalence of childhood obesity by income and education of household head varied across race/Hispanic origin groups (4). CDC analyzed 2011-2014 data from the National Health and Nutrition Examination Survey (NHANES) to obtain estimates of childhood obesity prevalence by household income (</=130%, >130% to </=350%, and >350% of the federal poverty level [FPL]) and head of household education level (high school graduate or less, some college, and college graduate). During 2011-2014 the prevalence of obesity among U.S. youths (persons aged 2-19 years) was 17.0%, and was lower in the highest income group (10.9%) than in the other groups (19.9% and 18.9%) and also lower in the highest education group (9.6%) than in the other groups (18.3% and 21.6%). Continued progress is needed to reduce disparities, a goal of Healthy People 2020. The overall Healthy People 2020 target for childhood obesity prevalence is <14.5% (5).

Studies have suggested that obesity prevalence varies by income and educational level, although patterns might differ between high-income and low-income countries (1-3). Previous analyses of U.S. data have shown that the prevalence of obesity varied by income and education, but results were not consistent by sex and race/Hispanic origin (4). Using data from the National Health and Nutrition Examination Survey (NHANES), CDC analyzed obesity prevalence among adults (aged >/=20 years) by three levels of household income, based on percentage (</=130%, >130% to </=350%, and >350%) of the federal poverty level (FPL) and individual education level (high school graduate or less, some college, and college graduate). During 2011-2014, the age-adjusted prevalence of obesity among adults was lower in the highest income group (31.2%) than the other groups (40.8% [>130% to </=350%] and 39.0% [</=130%]). The age-adjusted prevalence of obesity among college graduates was lower (27.8%) than among those with some college (40.6%) and those who were high school graduates or less (40.0%). The patterns were not consistent across all sex and racial/Hispanic origin subgroups. Continued progress is needed to achieve the Healthy People 2020 targets of reducing age-adjusted obesity prevalence to <30.5% and reducing disparities.

BACKGROUND: Obesity is a risk factor for asthma. However, it is unclear if increased obesity prevalence contributed to rising childhood asthma prevalence. OBJECTIVE: To assess if population-level changes in weight status impacted asthma prevalence over time. METHODS: Using nationally representative 1988-2014 National Health and Nutrition Examination Survey data for 40 644 children aged 2-19 years, we analyzed asthma trends by weight status (body mass index age-specific percentiles determined using measured weight and height). Logistic regression and population attributable fraction were used to assess the association between obesity and asthma prevalence. RESULTS: Although obesity was a risk factor for asthma throughout the period, asthma prevalence increased only among children with normal weight; there was no interaction between weight status and time. The population attributable fraction for overweight/obesity rose from 8.5% in 1988-1994 to 11.9% in 2011-2014, but this increase was not significant (P = 0.44). CONCLUSIONS: Together, these data do not support a contribution of obesity trends to asthma prevalence trends.

OBJECTIVE: To ascertain and compare the oral health status and related sociodemographic risk indicators in children in Los Angeles (LA) County with children in the United States. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were used to calculate prevalence estimates for children aged 2-13 years living in LA County and in the United States. Sociodemographic indicators were evaluated using multiple logistic regression modeling. RESULTS: Overall, children in LA County were more likely to experience dental caries than children in the United States in 1999-2004. In the primary dentition, nearly 40% of preschool children residing in LA County had dental caries compared to 28% of same-age children in the United States. Among children aged 6-13, 44% living in LA County had dental caries in the permanent dentition compared to 27% in the United States. Mexican American children in LA County had higher caries experience in permanent teeth (but not in primary teeth) than US Mexican American children. Among children aged 6-9 years, there was no difference in the prevalence of dental sealants in permanent teeth between those living in LA County and in the United States. However, among children aged 10-13 years, dental sealants were more than twice as prevalent in US children (40.8%) than in LA County children (17.5%). Among LA County children, the adjusted odds of having caries experience or untreated dental caries in permanent teeth were not higher among children from lower income families than in lower income children in the United States. CONCLUSIONS: Children residing in LA County had less favorable oral health than children in the United States in 1999-2004. The usual sociodemographic caries risk indicators identified among children in the United States were not consistently observed among children in LA County. Unlike in the wider United States, poverty was not a risk indicator for dental caries in older children in LA County.

IMPORTANCE: Between 1980 and 2000, the prevalence of obesity increased significantly among adult men and women in the United States; further significant increases were observed through 2003-2004 for men but not women. Subsequent comparisons of data from 2003-2004 with data through 2011-2012 showed no significant increases for men or women. OBJECTIVE: To examine obesity prevalence for 2013-2014 and trends over the decade from 2005 through 2014 adjusting for sex, age, race/Hispanic origin, smoking status, and education. DESIGN, SETTING, AND PARTICIPANTS: Analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative health examination survey of the US civilian noninstitutionalized population that includes measured weight and height. EXPOSURES: Survey period. MAIN OUTCOMES AND MEASURES: Prevalence of obesity (body mass index ≥30) and class 3 obesity (body mass index ≥40). RESULTS: This report is based on data from 2638 adult men (mean age, 46.8 years) and 2817 women (mean age, 48.4 years) from the most recent 2 years (2013-2014) of NHANES and data from 21,013 participants in previous NHANES surveys from 2005 through 2012. For the years 2013-2014, the overall age-adjusted prevalence of obesity was 37.7% (95% CI, 35.8%-39.7%); among men, it was 35.0% (95% CI, 32.8%-37.3%); and among women, it was 40.4% (95% CI, 37.6%-43.3%). The corresponding prevalence of class 3 obesity overall was 7.7% (95% CI, 6.2%-9.3%); among men, it was 5.5% (95% CI, 4.0%-7.2%); and among women, it was 9.9% (95% CI, 7.5%-12.3%). Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity (P = .004) and for class 3 obesity (P = .01) but not among men (P = .30 for overall obesity; P = .14 for class 3 obesity). CONCLUSIONS AND RELEVANCE: In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity in 2013-2014 was 35.0% among men and 40.4% among women. The corresponding values for class 3 obesity were 5.5% for men and 9.9% for women. For women, the prevalence of overall obesity and of class 3 obesity showed significant linear trends for increase between 2005 and 2014; there were no significant trends for men. Other studies are needed to determine the reasons for these trends.

IMPORTANCE: Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years. OBJECTIVES: To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014. DESIGN, SETTING, AND PARTICIPANTS: Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys. EXPOSURES: Survey period. MAIN OUTCOMES AND MEASURES: Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted. RESULTS: Measurements from 40,780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87). CONCLUSIONS AND RELEVANCE: In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.

INTRODUCTION: Although decline in muscle mass and quality and resulting declines in muscle strength are associated with aging, more research is needed in general populations to assess the utility of handgrip strength as an indicator of muscle strength and cardiovascular disease risk. METHODS: Data from 4,221 participants aged ≥20 years in the 2011-2012 cycle of National Health and Nutrition Examination Survey were analyzed during 2014-2015. Standing isometric relative handgrip strength (calculated as maximal absolute handgrip strength from both hands divided by BMI) was used to predict cardiovascular biomarkers, including blood pressure (measured systolic and diastolic blood pressure); serum lipids (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides); and plasma insulin and glucose. RESULTS: Results from regression analyses showed that higher relative grip strength was significantly associated with lower systolic blood pressure, triglycerides, and plasma insulin and glucose, and higher high-density lipoprotein cholesterol in male and female participants (p<0.05 for all). Secondary descriptive analyses found that absolute handgrip strength increased significantly with increasing weight status, but relative handgrip strength decreased significantly with increasing weight status. CONCLUSIONS: Results suggest that increased relative handgrip strength may be associated with a better profile of cardiovascular health biomarkers among U.S. adults. Relative grip strength, which both adjusts for the confounding of mass and assesses concomitant health risks of increased body size and low muscle strength, may be a useful public health measure of muscle strength.

INTRODUCTION: Cardiovascular disease remains an important cause of death in the U.S. where veterans of the U.S. Armed Forces represent a significant segment of the population. Limited national estimates of cardiovascular disease risk factors using physical measurements and reported veteran status in the U.S. civilian population have been reported. The purpose of this study was to compare the prevalence of cardiovascular disease risk factors among veteran and non-veteran men in the U.S. civilian population. METHODS: Using data from the 2009-2012 National Health and Nutrition Examination Surveys, 1,107 veteran and 3,972 non-veteran men were identified for this study (analyzed in 2014-2015). Differences in hypertension, dsylipidemia, diabetes, obesity, and smoking between veterans and non-veterans were compared using chi-square and t-tests. Predicted prevalence from multivariable logistic regression models adjusted for age, race/Hispanic origin, and poverty level were used to assess whether previous military service was associated with having a cardiovascular disease risk factor. RESULTS: Veteran men were older than non-veteran men (59.9 years vs 43.4 years) and were more likely to be non-Hispanic white (79.9% vs 65.7%). Adjusted predicted prevalence estimates show that veterans were more likely than non-veterans to be obese (42.6% vs 33.7%, p<0.01). After adjustment for obesity, there was no difference in hypertension, dyslipidemia, diagnosed diabetes, or smoking between veteran and non-veteran men. CONCLUSIONS: This study identified a segment of the U.S. civilian population-veteran men-who have a higher prevalence for obesity, a risk factor associated with increased risk for other cardiovascular disease risk factors.

BACKGROUND AND OBJECTIVES: Regular aerobic and muscle-strengthening physical activity in youth has been positively associated with health and may help prevent obesity. The purpose of this study is to provide reference values on 4 core, upper, and lower body measures of muscle strength among US children and adolescents and to investigate the association between these measures of strength and weight status. METHODS: We assessed muscular strength using 4 different tests (plank, modified pull-up, knee extension, and grip strength) in 1224 youth aged 6 to 15 years collected during the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Mean and median estimates are provided by gender, age, and weight status. Weight status was defined based on standard categories of obesity, overweight, normal weight, and underweight using the gender-specific BMI-for-age Centers for Disease Control and Prevention growth charts. RESULTS: There were significant positive trends with age for each of the strength tests (P < .001) except the modified pull-up among girls. The length of time the plank was held decreased as weight status increased for both girls and boys (P < .001). As weight status increased the number of modified pull-ups decreased (P < .001 boys and girls). Scores on the knee extension increased as weight status increased (P < .01). Grip strength increased as weight status increased (P < .01). CONCLUSIONS: Increasing weight status had a negative association with measures of strength that involved lifting the body, but was associated with improved performances on tests that did not involve lifting the body.

Eliminating health disparities among different segments of the population is one of two overarching goals of both Healthy People 2010 and 2020 (1). Race/ethnicity differences in health care and chronic diseases have been well documented (2,3). Hypertension, hypercholesterolemia, and diabetes are all chronic conditions associated with cardiovascular disease, the leading cause of death in the United States. The co-occurrence of these three chronic conditions by race/ethnicity has been less frequently documented. In addition, reliance on only self-reported diagnosis results in an underestimate of the prevalence of these conditions. The objective of this report is to compare the prevalence of diagnosed and undiagnosed hypertension, hypercholesterolemia, and diabetes among three racial/ethnic groups and the prevalence of co-morbidity of these conditions for U.S. adults.