Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 36 Records) |
Query Trace: Kit BK[original query] |
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Prevalence and correlates of receiving medical advice to increase physical activity in U.S. adults: National Health and Nutrition Examination Survey 2013-2016
Zwald ML , Kit BK , Fakhouri THI , Hughes JP , Akinbami LJ . Am J Prev Med 2019 56 (6) 834-843 INTRODUCTION: National objectives recommend healthcare professionals provide physical activity advice. This study examined health and demographic characteristics associated with receipt of medical advice to increase physical activity among U.S. health care-utilizing adults and differences in associations by age group. METHODS: Analyses included 8,410 health care-utilizing adults aged >/=20 years from the 2013-2016 National Health and Nutrition Examination Surveys (analyzed in 2018). Logistic regression was used to examine associations between receipt of medical advice to increase physical activity in the past year and measured health conditions, reported health behaviors, and demographic characteristics. Models were stratified by age group (20-39, 40-59, and >/=60 years). RESULTS: Physical activity medical advice was received by 42.9% (95% CI=40.8, 44.9) of adults overall. By age group, 32.7% of younger adults, 46.7% of middle-aged adults, and 48.9% of older adults received advice. Among all adults and across all age groups, receipt of advice was higher among adults with chronic health conditions: obesity (63.0%, 95% CI=60.3, 65.7), hypertension (56.5%, 95%=CI 53.8, 59.2), diabetes (69.8%, 95% CI=66.5, 72.8), hypercholesterolemia (55.6%, 95% CI=52.3, 59.0), and low high-density lipoprotein cholesterol (53.8%, 95% CI=50.1, 57.4). Among all adults, those with obesity, hypertension, and diabetes had significantly greater odds of receipt of advice after adjustment. Stronger associations between diabetes and hypercholesterolemia and receiving physical activity advice were observed among younger adults. CONCLUSIONS: Receipt of physical activity medical advice was highest among adults with specific chronic health conditions, and this pattern was stronger among younger adults with diabetes and hypercholesterolemia. However, most health care-utilizing adults did not receive physical activity medical advice. |
Trends in prescription medication use among children and adolescents - United States, 1999-2014
Hales CM , Kit BK , Gu Q , Ogden CL . JAMA 2018 319 (19) 2009-2020 Importance: Access to appropriate prescription medications, use of inappropriate or ineffective treatments, and adverse drug events are public health concerns among US children and adolescents. Objective: To evaluate trends in use of prescription medications among US children and adolescents. Design, Setting, and Participants: US children and adolescents aged 0 to 19 years in the 1999-2014 National Health and Nutrition Examination Survey (NHANES)-serial cross-sectional, nationally representative surveys of the civilian noninstitutionalized population. Exposures: Sex, age, race and Hispanic origin, household income and education, insurance status, current health status. Main Outcomes and Measures: Use of any prescription medications or 2 or more prescription medications taken in the past 30 days; use of medications by therapeutic class; trends in medication use across 4-year periods from 1999-2002 to 2011-2014. Data were collected though in-home interview and direct observation of the prescription container. Results: Data on prescription medication use were available for 38277 children and adolescents (mean age, 10 years; 49% girls). Overall, use of any prescription medication in the past 30 days decreased from 24.6% (95% CI, 22.6% to 26.6%) in 1999-2002 to 21.9% (95% CI, 20.3% to 23.6%) in 2011-2014 (beta = -0.41 percentage points every 2 years [95% CI, -0.79 to -0.03]; P = .04), but there was no linear trend in the use of 2 or more prescription medications (8.5% [95% CI, 7.6% to 9.4%] in 2011-2014). In 2011-2014, the most commonly used medication classes were asthma medications (6.1% [95% CI, 5.4% to 6.8%]), antibiotics (4.5% [95% CI, 3.7% to 5.5%]), attention-deficit/hyperactivity disorder (ADHD) medications (3.5% [95% CI, 2.9% to 4.2%]), topical agents (eg, dermatologic agents, nasal steroids) (3.5% [95% CI, 3.0% to 4.1%]), and antihistamines (2.0% [95% CI, 1.7% to 2.5%]). There were significant linear trends in 14 of 39 therapeutic classes or subclasses, or in individual medications, with 8 showing increases, including asthma and ADHD medications and contraceptives, and 6 showing decreases, including antibiotics, antihistamines, and upper respiratory combination medications. Conclusions and Relevance: In this study of US children and adolescents based on a nationally representative survey, estimates of prescription medication use showed an overall decrease in use of any medication from 1999-2014. The prevalence of asthma medication, ADHD medication, and contraceptive use increased among certain age groups, whereas use of antibiotics, antihistamines, and upper respiratory combination medications decreased. |
Bias in hazard ratios arising from misclassification according to self-reported weight and height in observational studies of body mass index and mortality
Flegal KM , Kit BK , Graubard BI . Am J Epidemiol 2018 187 (1) 125-134 Misclassification of body mass index (BMI) categories arising from self-reported weight and height can bias hazard ratios in studies of BMI and mortality. We examined the effects on hazard ratios of such misclassification using national US survey data for 1976 through 2010 that had both measured and self-reported weight and height along with mortality follow-up for 48,763 adults and a subset of 17,405 healthy never-smokers. BMI was categorized as <22.5 (low), 22.5-24.9 (referent), 25.0-29.9 (overweight), 30.0-34.9 (class I obesity), and >/=35.0 (class II-III obesity). Misreporting at higher BMI categories tended to bias hazard ratios upwards for those categories, but that effect was augmented, counterbalanced, or even reversed by misreporting in other BMI categories, in particular those that affected the reference category. For example, among healthy male never-smokers, misclassifications affecting the overweight and the reference categories changed the hazard ratio for overweight from 0.85 with measured data to 1.24 with self-reported data. Both the magnitude and direction of bias varied according to the underlying hazard ratios in measured data, showing that findings on bias from one study should not be extrapolated to a study with different underlying hazard ratios. Because of misclassification effects, self-reported weight and height cannot reliably indicate the lowest-risk BMI category. |
Contribution of weight status to asthma prevalence racial disparities, 2-19 year olds, 1988-2014
Akinbami LJ , Rossen LM , Fakhouri THI , Simon AE , Kit BK . Ann Epidemiol 2017 27 (8) 472-478 e3 PURPOSE: Racial disparities in childhood asthma prevalence increased after the 1990s. Obesity, which also varies by race/ethnicity, is an asthma risk factor but its contribution to asthma prevalence disparities is unknown. METHODS: We analyzed nationally representative National Health Examination and Nutrition Survey data for 2-19 year olds with logistic regression and decomposition analyses to assess the contributions of weight status to racial disparities in asthma prevalence, controlling for sex, age, and income status. RESULTS: From 1988-1994 to 2011-2014, asthma prevalence increased more among non-Hispanic black (NHB) (8.4% to 18.0%) than non-Hispanic white (NHW) youth (7.2% to 10.3%). Logistic regression showed that obesity was an asthma risk factor for all groups but that a three-way "weight status-race/ethnicity-time" interaction was not significant. That is, weight status did not modify the race/ethnicity association with asthma over time. In decomposition analyses, weight status had a small contribution to NHB/NHW asthma prevalence disparities but most of the disparity remained unexplained by weight status or other asthma risk factors (sex, age and income status). CONCLUSIONS: NHB youth had a greater asthma prevalence increase from 1988-1994 to 2011-2014 than NHW youth. Most of the racial disparity in asthma prevalence remained unexplained after considering weight status and other characteristics. |
Factors associated with home blood pressure monitoring among US adults: National Health and Nutrition Examination Survey, 2011-2014
Ostchega Y , Zhang G , Kit BK , Nwankwo T . Am J Hypertens 2017 30 (11) 1126-1132 BACKGROUND: Home blood pressure monitoring (HBPM) has a substantial role in hypertension management and control. METHODS: Cross-sectional data for noninstitutionalized US adults 18 years and older (10,958) from the National Health and Nutrition Examination Survey (NHANES), years 2011-2014, were used to examine factors related to HBPM. RESULTS: In 2011-2014, estimated 9.5% of US adults engaged in weekly HBPM, 7.2% engaged in monthly HBPM, 8.0% engaged in HBPM less than once a month, and 75.3% didn't engage any HBPM. The frequency of HBPM increased with age, body mass index, and the number of health care visits (all, P < 0.05). Also, race/ethnicity (Non-Hispanic Blacks and non-Hispanic Asians), health insurance, diagnosed with diabetes, told by a health care provider to engage in HBPM, and diagnosed as hypertensive, were all associated with more frequent HBPM (P < 0.05). Adjusting for covariates, hypertensives who were aware of, treated for, and controlled engaged in more frequent HBPM compared to their respective references: unaware (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.53-2.63), untreated (OR = 1.99, 95% CI = 1.52-2.60), and uncontrolled (OR = 1.42, 95% CI = 1.13-1.82). Hypertensive adults (aware/unaware, treated/untreated, or controlled/uncontrolled), who received providers' recommendations to perform HBPM, were more likely to do so compared to those who did not receive recommendations (OR = 8.04, 95% CI = 6.56-9.86; OR = 7.98, 95% CI = 6.54-9.72; OR = 8.75, 95% CI = 7.18-10.67, respectively). CONCLUSIONS: Seventeen percent of US adults engaged in monthly or more frequent HBPM and health care providers' recommendations to engage in HBPM have a significant impact on the frequency of HBPM. |
Prevalence of high fractional exhaled nitric oxide among US youth with asthma
Nguyen DT , Kit BK , Brody D , Akinbami LJ . Pediatr Pulmonol 2017 52 (6) 737-745 BACKGROUND: High fractional exhaled nitric oxide (FeNO) is an indicator of poor asthma control and has been proposed as a non-invasive assessment tool to guide asthma management. OBJECTIVE: We aimed to describe the prevalence of and factors associated with high FeNO among US youth with asthma. METHODS: Data from 716 children and adolescents with asthma ages 6-19 years who participated in the 2007-2012 National Health and Nutrition Examination Survey were analyzed. Using American Thoracic Society guidelines, high FeNO was defined as >50 ppb for ages 12-19 years and >35 ppb for ages 6-11 years. Multivariate logistic regression examined associations between high FeNO and age, sex, race/Hispanic origin, income status, weight status, tobacco smoke exposure, and other factors associated with asthma control (recent use of inhaled corticosteroids, recent respiratory illness, asthma-related respiratory signs/symptoms, and spirometry). RESULTS: About 16.5% of youth with asthma had high FeNO. The prevalence of high FeNO was higher among non-Hispanic black (27%, P < 0.001) and Hispanic (20.2%, P = 0.002) youth than non-Hispanic white (9.7%) youth. Differences in high FeNO prevalence by sex (girls < boys), weight status (obese < normal weight), tobacco smoke exposure (smokers < home exposure < no exposure), and FEV1/FVC (normal < abnormal) were also observed. No differences were noted between categories for the remaining covariates. CONCLUSION: High FeNO was observed to be associated with sex, race/Hispanic origin, weight status, tobacco smoke exposure, and abnormal FEV1/FVC, but was not associated with asthma-related respiratory symptoms. These findings may help inform future research and clinical practice guidelines on the use of high FeNO in the assessment of asthma control. |
Trends in anthropometric measures among US children 6 to 23 months, 1976-2014
Akinbami LJ , Kit BK , Carroll MD , Fakhouri TH , Ogden CL . Pediatrics 2017 139 (3) BACKGROUND AND OBJECTIVES: The surveillance of children's growth reflects a population's nutritional status and risk for adverse outcomes. This study aimed to describe trends in length-for-age, weight-for-age, weight-for-length, and early childhood weight gain among US children aged 6 to 23 months. METHODS: We analyzed NHANES data from 1976-1980, 1988-1994, 1999-2002, 2003-2006, 2007-2010, and 2011-2014. We estimated z scores < -2 (low) and ≥+2 (high) in comparison with World Health Organization growth standards for each indicator. Weight gain (relative to sex-age-specific medians) from birth until survey participation was estimated. Trends were assessed by low birth weight status and race/Hispanic origin. Race/Hispanic origin trends were assessed from 1988-1994 to 2011-2014. RESULTS: In 2011-2014, the prevalence of low and high length-for-age was 3.3% (SE, 0.8) and 3.7% (SE, 0.8); weight-for-age was 0.6% (SE, 0.3) and 7.0% (SE, 1.1); and weight-for-length was 1.0% (SE, 0.4) and 7.7% (SE, 1.2). The only significant trend was a decrease in high length-for-age (5.5% in 1976-1980 vs 3.7% in 2011-2014; P = .04). Relative weight gain between birth and survey participation did not differ over time, although trends differed by race/Hispanic origin. Non-Hispanic black children gained more weight between birth and survey participation in 2011-2014 versus 1988-1994, versus no change among other groups. CONCLUSIONS: Between 1976-1980 and 2011-2014, there were no significant trends in low or high weight-for-age and weight-for-length among 6- to 23-month-old children whereas the percent with high length-for-age decreased. A significant trend in relative weight gain between birth and survey participation was observed among non-Hispanic black children. |
Gross motor development in children aged 3-5 years, United States 2012
Kit BK , Akinbami LJ , Isfahani NS , Ulrich DA . Matern Child Health J 2017 21 (7) 1573-1580 Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which included TGMD-2 scores obtained according to an established protocol. Outcome measures included locomotor and object control raw and age-standardized scores. Means and standard errors were calculated for demographic and weight status with SUDAAN using sample weights to calculate nationally representative estimates, and survey design variables to account for the complex sampling methods. Results The sample included 339 children aged 3-5 years. As expected, locomotor and object control raw scores increased with age. Overall mean standardized scores for locomotor and object control were similar to the mean value previously determined using a normative sample. Girls had a higher mean locomotor, but not mean object control, standardized score than boys (p < 0.05). However, the mean locomotor standardized scores for both boys and girls fell into the range categorized as "average." There were no other differences by age, race/Hispanic origin, weight status, or income in either of the subtest standardized scores (p > 0.05). Conclusions In a nationally representative sample of US children aged 3-5 years, TGMD-2 mean locomotor and object control standardized scores were similar to the established mean. These results suggest that standardized gross motor development among young children generally did not differ by demographic or weight status. |
Normative values for cardiorespiratory fitness testing among US children aged 6-11 years
Gahche JJ , Kit BK , Fulton JE , Carroll DD , Rowland T . Pediatr Exerc Sci 2017 29 (2) 1-23 BACKGROUND: Nationally representative normative values for cardiorespiratory fitness (CRF) have not been described for US children since the mid 1980's. OBJECTIVE: To provide sex- and age-specific normative values for CRF of US children aged 6-11 years. METHODS: Data from 624 children aged 6-11 years who participated in the CRF testing as part of the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey, a cross-sectional survey, were analyzed. Participants were assigned to one of three age-specific protocols and asked to exercise to volitional fatigue. The difficulty of the protocols increased with successive age groups. CRF was assessed as maximal endurance time (min:sec). Data analysis was conducted in 2016. RESULTS: For 6-7, 8-9, 10-11 year olds, corresponding with the age-specific protocols, mean endurance time was 12:10 min:sec (95% CI: 11:49-12:31), 11:16 min:sec (95% CI: 11:00-11:31), and 10:01 min:sec (95% CI: 9:37-10:25), respectively. Youth in the lowest 20th percentile for endurance time were more likely to be obese, to report less favorable health, and to report greater than two hours of screen time per day. CONCLUSION: These data may serve as baseline estimates to monitor trends over time in CRF among US children aged 6-11 years. |
Trends in breastfeeding initiation and duration by birth weight among US children, 1999-2012
Herrick KA , Rossen LM , Kit BK , Wang CY , Ogden CL . JAMA Pediatr 2016 170 (8) 805-7 In the United States, breastfeeding initiation rates have risen to 80%.1 We report secular trends of breastfeeding initiation and duration by birth weight using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). |
Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014
Ogden CL , Carroll MD , Lawman HG , Fryar CD , Kruszon-Moran D , Kit BK , Flegal KM . JAMA 2016 315 (21) 2292-9 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. |
Interrelationships between BMI, skinfold thicknesses, percent body fat, and cardiovascular disease risk factors among U.S. children and adolescents
Freedman DS , Ogden CL , Kit BK . BMC Pediatr 2015 15 (1) 188 BACKGROUND: Although the estimation of body fatness by Slaughter skinfold thickness equations (PBFSlaughter) has been widely used, the accuracy of this method is uncertain. We have previously examined the interrelationships among the body mass index (BMI), PBFSlaughter, percent body fat from dual energy X-ray absorptiometry (PBFDXA) and CVD risk factor levels among children who were examined in the Bogalusa Heart Study and in the Pediatric Rosetta Body Composition Project. The current analyses examine these associations among 7599 8- to 19-year-olds who participated in the (U.S.) National Health and Nutrition Examination Survey from 1999 to 2004. METHODS: We analyzed (1) the agreement between (1) estimates of percent body fat calculated from the Slaughter skinfold thickness equations and from DXA, and (2) the relation of lipid, lipoprotein, and blood pressure levels to BMI, PBFSlaughter and PBFDXA. RESULTS: PBFSlaughter was highly correlated (r ~ 0.85) with PBFDXA. However, among children with a relatively low skinfold thicknesses sum (triceps + subscapular), PBFSlaughter underestimated PBFDXA by 8 to 9 percentage points. In contrast, PBFSlaughter overestimated PBFDXA by 10 points among boys with a skinfold thickness sum ≥ 50 mm. After adjustment for sex and age, lipid levels were related similarly to the body mass index, PBFDXA and PBFSlaughter. There were, however, small differences in associations with blood pressure levels: systolic blood pressure was more strongly associated with body mass index, but diastolic blood pressure was more strongly associated with percent body fat. CONCLUSIONS: The Slaughter equations yield biased estimates of body fatness. In general, lipid and blood pressure levels are related similarly to levels of BMI (following adjustment for sex and age), PBFSlaughter, and PBFDXA. |
Are the recent secular increases in waist circumference among children and adolescents independent of changes in BMI?
Freedman DS , Kit BK , Ford ES . PLoS One 2015 10 (10) e0141056 BACKGROUND: Several studies have shown that the waist circumference of children and adolescents has increased over the last 25 years. However, given the strong correlation between waist circumference and BMI, it is uncertain if the secular trends in waist circumference are independent of those in BMI. METHODS: We analyzed data from 6- to 19-year-olds who participated in the 1988-1994 through 2011-2012 cycles of the National Health and Nutrition Examination Survey to assess whether the trends in waist circumference were independent of changes in BMI, race-ethnicity and age. RESULTS: Mean, unadjusted levels of waist circumference increased by 3.7 cm (boys) and 6.0 cm (girls) from 1988-94 through 2011-12, while mean BMI levels increased by 1.1 kg/m2 (boys) and 1.6 kg/m2 (girls). Overall, the proportional changes in mean levels of both waist circumference and BMI were fairly similar among boys (5.3%, waist vs. 5.6%, BMI) and girls (8.7%, waist vs. 7.7%, BMI). As assessed by the area under the curve, adjustment for BMI reduced the secular increases in waist circumference by about 75% (boys) and 50% (girls) beyond that attributable to age and race-ethnicity. There was also a race-ethnicity interaction (p < 0.001). Adjustment for BMI reduced the secular trend in waist circumference among non-Hispanic (NH) black children (boys and girls) to a greater extent (about 90%) than among other children. CONCLUSIONS: Our results indicate that among children in the U.S., about 75% (boys) and 50% (girls) of the secular increases in waist circumference since 1988-94 can be accounted for by changes in BMI. The reasons for the larger independent effects among girls and among NH blacks are uncertain. |
Trends in the use of prescription antibiotics: NHANES 1999-2012
Frenk SM , Kit BK , Lukacs SL , Hicks LA , Gu Q . J Antimicrob Chemother 2015 71 (1) 251-6 OBJECTIVES: The objectives of this study were: to examine trends in the use of prescription antibiotics overall and by population subgroups between 1999 and 2012; and to examine trends in the use of categories of antibiotics and individual antibiotics. METHODS: Use of antibiotics was examined among 71 444 participants in the nationally representative National Health and Nutrition Examination Survey (NHANES; 1999-2012). Use of an antibiotic in the past 30 days was the main outcome variable. Analyses of trends were conducted overall and separately by population subgroups (i.e. age, sex, race/Hispanic origin, health insurance status and respiratory conditions) across four time periods (1999-2002, 2003-06, 2007-10 and 2011-12). RESULTS: The percentage of the US population that used a prescription antibiotic in the past 30 days significantly declined from 6.1% in 1999-2002 to 4.1% in 2011-12 (P < 0.001). Declines were also identified for five age groups (0-1 year, 6-11 years, 12-17 years, 18-39 years and 40-59 years), both sexes, non-Hispanic white and non-Hispanic black persons, persons with and without insurance and among those who currently had asthma. Significant declines were also observed for three categories of antibiotics (penicillins, cephalosporins and macrolide derivatives). Of the most common antibiotics prescribed, only amoxicillin use decreased significantly. CONCLUSIONS: Overall, there was a significant decline in the use of antibiotics between 1999-2002 and 2011-12. Due to concerns about antimicrobial resistance, it is important to continue monitoring the use of antibiotics. |
Differences in spirometry values between US children 6-11 years and adolescents 12-19 years with current asthma, 2007-2010
Kit BK , Simon AE , Tilert T , Okelo S , Akinbami LJ . Pediatr Pulmonol 2015 51 (3) 272-9 BACKGROUND: National Asthma Education and Prevention Program (NAEPP) guidelines recommend that periodic spirometry be performed in youth with asthma. NAEPP uses different spirometry criteria to define uncontrolled asthma for children (6-11 years) and adolescents (12+ years). OBJECTIVE: To describe differences in spirometry between US children and adolescents with current asthma. METHODS: We examined cross-sectional spirometry data from 453 US youth with current asthma age 6-19 years from the 2007-2010 National Health and Nutrition Examination Surveys. The main outcomes were percentage predicted forced expiratory volume at 1 sec (FEV1%) ≤80 and the ratio of FEV1 to forced vital capacity (FEV1/FVC) ≤0.80. We also examined the prevalence of youth with spirometry values consistent with uncontrolled asthma, using NAEPP age-specific criteria, defined for children aged 6-11 years as FEV1% ≤80 or FEV1/FVC ≤0.80, and for adolescents aged 12-19 years as FEV1% ≤80. RESULTS: Children 6-11 years and adolescents 12-19 years did not differ in prevalence of FEV1% ≤80 (10.1% vs. 9.0%) or FEV1/FVC ≤0.80 (30.6% vs. 29.8%). However, based on the NAEPP age-specific criteria, 33.0% of children 6-11 years and 9.0% of adolescents 12-19 years had spirometry values consistent with uncontrolled asthma (P < 0.001). CONCLUSION: Children 6-11 years and adolescents 12-19 years with current asthma did not differ in the percentage with FEV1% ≤80 or FEV1/FVC ≤0.80. However, the percent of children and adolescents with spirometry values consistent with uncontrolled asthma did differ. The difference appears to stem mainly from the different spirometry criteria for the two age groups. |
More than half of US youth consume seafood and most have blood mercury concentrations below the EPA reference level, 2009-2012
Nielsen SJ , Aoki Y , Kit BK , Ogden CL . J Nutr 2015 145 (2) 322-7 BACKGROUND: Consuming seafood has health benefits, but seafood can also contain methylmercury, a neurotoxicant. Exposure to methylmercury affects children at different stages of brain development, including during adolescence. OBJECTIVE: The objective was to examine seafood consumption and blood mercury concentrations in US youth. METHODS: In the 2009-2012 NHANES, a cross-sectional nationally representative sample of the US population, seafood consumption in the past 30 d and blood mercury concentrations on the day of examination were collected from 5656 youth aged 1-19 y. Log-linear regression was used to examine the association between frequency of specific seafood consumption and blood mercury concentration, adjusting for race/Hispanic origin, sex, and age. RESULTS: In 2009-2012, 62.4% +/- 1.4% (percent +/- SE) of youth consumed any seafood in the preceding month; 38.4% +/- 1.4% and 48.5% +/- 1.5% reported consuming shellfish and fish, respectively. In 2009-2012, the geometric mean blood mercury concentration was 0.50 +/- 0.02 mug/L among seafood consumers and 0.27 +/- 0.01 mug/L among those who did not consume seafood. Less than 0.5% of youth had blood mercury concentrations ≥5.8 mug/L. In adjusted log-linear regression analysis, no significant associations were observed between frequency of breaded fish or catfish consumption and blood mercury concentrations, but frequency of consuming certain seafood types had significant positive association with blood mercury concentrations: high-mercury fish (swordfish and shark) [exponentiated beta coefficient (expbeta): 2.40; 95% CI: 1.23, 4.68]; salmon (expbeta: 1.41; 95% CI: 1.26, 1.55); tuna (expbeta: 1.38; 95% CI: 1.29, 1.45); crabs (expbeta: 1.35; 95% CI: 1.17, 1.55); shrimp (expbeta: 1.12; 95% CI: 1.05, 1.20), and all other seafood (expbeta: 1.23; 95% CI: 1.17, 1.32). Age-stratified log-linear regression analyses produced similar results. CONCLUSION: Few US youth have blood mercury concentrations ≥5.8 mug/L, although more than half of US youth consumed seafood in the past month. |
Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999-2012
Kit BK , Kuklina E , Carroll MD , Ostchega Y , Freedman DS , Ogden CL . JAMA Pediatr 2015 169 (3) 272-9 IMPORTANCE: Recent national data suggest there were improvements in serum lipid concentrations among US children and adolescents between 1988 and 2010 but an increase in or stable blood pressure (BP) during a similar period. OBJECTIVE: To describe the prevalence of and trends in dyslipidemia and adverse BP among US children and adolescents. DESIGN: The National Health and Nutrition Examination Survey, a cross-sectional survey. Setting: Noninstitutionalized US population. PARTICIPANTS: Children and adolescents aged 8 to 17 years with measured lipid concentrations (n = 1482) and BP (n = 1665). MAIN OUTCOMES AND MEASURES: Adverse concentrations of total cholesterol (TC) (≥200 mg/dL), high-density lipoprotein cholesterol (HDL-C) (<40 mg/dL), and non-HDL-C (≥145 mg/dL) (to convert TC, HDL-C, and non-HDL-C to millimoles per liter, multiply by 0.0259) and high or borderline BP were examined. Definitions of BP were informed by the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Analyses of linear trends in dyslipidemias and BP were conducted overall and separately by sex across 7 periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012). RESULTS: In 2011-2012, 20.2% (95% CI, 16.3-24.6) of youths had an adverse concentration of TC, HDL-C, or non-HDL-C and 11.0% (95% CI, 8.8-13.4) had either high or borderline BP. The prevalences of adverse concentrations decreased between 1999-2000 and 2011-2012 for TC (10.6% [95% CI, 8.3-13.2] vs 7.8% [95% CI, 5.7-10.4]; P = .006), HDL-C (17.9% [95% CI, 15.0-21.0] vs 12.8% [95% CI, 9.8-16.2]; P = .003), and non-HDL-C (13.6% [95% CI, 11.3-16.2] vs 8.4% [95% CI, 5.9-11.5]; P < .001). There was a decrease in high BP between 1999-2000 (3.0% [95% CI, 2.0-4.3]) and 2011-2012 (1.6% [95% CI, 1.0-2.4]) (P = .003). There was no change from 1999-2000 to 2011-2012 in borderline high BP (7.6% [95% CI, 5.8-9.8] vs 9.4% [95% CI, 7.2-11.9]; P = .90) or either high or borderline high BP (10.6% [8.4-13.1] vs 11.0% [95% CI, 8.8-13.4]; P = .26). CONCLUSIONS AND RELEVANCE: In 2011-2012, approximately 1 in 5 children and adolescents aged 8 to 17 years had an adverse lipid concentration of TC, HDL-C, or non-HDL-C and slightly more than 1 in 10 had either borderline high or high BP. The prevalence of dyslipidemia modestly decreased between 1999-2000 and 2011-2012, but either high or borderline high BP remained stable. The reasons for these trends require further study. |
Flegal et al. reply
Flegal KM , Kit BK , Graubard BI . Am J Epidemiol 2014 180 (11) 1129-30 We thank Dr. Stevens for her observations (1). We agree with Stevens that standardized body mass index (BMI; weight (kg)/height (m)2) cutpoints can aid comparisons among studies examining different populations. The standard BMI cutpoints of 18.5, 25, and 30, indicating underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), and obesity (≥30), were developed by the National Heart, Lung, and Blood Institute (2) and the World Health Organization (WHO) (3) and were reiterated in the 2013 obesity guidelines (4). Since their inception, these standards have been widely used in studies of BMI and risk of death and appear to be well accepted. In a previous systematic search (5), we found well over 100 published studies of weight and mortality as of 2012 that had reported results using those standard categories, including approximately half of the studies published since 2000. Turner et al. (6) used those BMI standards as their example of an approach to categorization that used well-recognized, published boundaries. In our article (7), we did not suggest that a new or augmented set of standards was needed. Rather, we emphasized that use of the current standard BMI groupings in analysis would avoid issues arising from ad hoc and post hoc selection of BMI categories. Finer BMI categories are not clearly necessary and can create problems of interpretation. |
Body mass index categories in observational studies of weight and risk of death
Flegal KM , Kit BK , Graubard BI . Am J Epidemiol 2014 180 (3) 288-96 The World Health Organization (Geneva, Switzerland) and the National Heart, Lung, and Blood Institute (Bethesda, Maryland) have developed standard categories of body mass index (BMI) (calculated as weight (kg)/height (m)(2)) of less than 18.5 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), and 30.0 or more (obesity). Nevertheless, studies of BMI and the risk of death sometimes use nonstandard BMI categories that vary across studies. In a meta-analysis of 8 large studies that used nonstandard BMI categories and were published between 1999 and 2014 and included 5.8 million participants, hazard ratios tended to be small throughout the range of overweight and normal weight. Risks were similar between subjects of high-normal weight (BMI of approximately 23.0-24.9) and those of low overweight (BMI of approximately 25.0-27.4). In an example using national survey data, minor variations in the reference category affected hazard ratios. For example, choosing high-normal weight (BMI of 23.0-24.9) instead of standard normal weight (BMI of 18.5-24.9) as the reference category produced higher nonsignificant hazard ratios (1.05 vs. 0.97 for men and 1.06 vs. 1.02 for women) for the standard overweight category (BMI of 25.0-29.9). Use of the standard BMI groupings avoids problems of ad hoc and post hoc category selection and facilitates between-study comparisons. The ways in which BMI data are categorized and reported may shape inferences about the degree of risk for various BMI categories. |
Prevalence of childhood and adult obesity in the United States, 2011-2012
Ogden CL , Carroll MD , Kit BK , Flegal KM . JAMA 2014 311 (8) 806-14 IMPORTANCE: More than one-third of adults and 17% of youth in the United States are obese, although the prevalence remained stable between 2003-2004 and 2009-2010. OBJECTIVE: To provide the most recent national estimates of childhood obesity, analyze trends in childhood obesity between 2003 and 2012, and provide detailed obesity trend analyses among adults. DESIGN, SETTING, AND PARTICIPANTS: Weight and height or recumbent length were measured in 9120 participants in the 2011-2012 nationally representative National Health and Nutrition Examination Survey. MAIN OUTCOMES AND MEASURES: In infants and toddlers from birth to 2 years, high weight for recumbent length was defined as weight for length at or above the 95th percentile of the sex-specific Centers for Disease Control and Prevention (CDC) growth charts. In children and adolescents aged 2 to 19 years, obesity was defined as a body mass index (BMI) at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts. In adults, obesity was defined as a BMI greater than or equal to 30. Analyses of trends in high weight for recumbent length or obesity prevalence were conducted overall and separately by age across 5 periods (2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012). RESULTS: In 2011-2012, 8.1% (95% CI, 5.8%-11.1%) of infants and toddlers had high weight for recumbent length, and 16.9% (95% CI, 14.9%-19.2%) of 2- to 19-year-olds and 34.9% (95% CI, 32.0%-37.9%) of adults (age-adjusted) aged 20 years or older were obese. Overall, there was no significant change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers, obesity in 2- to 19-year-olds, or obesity in adults. Tests for an interaction between survey period and age found an interaction in children (P = .03) and women (P = .02). There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P = .03) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%; P = .006). CONCLUSIONS AND RELEVANCE: Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance. |
Seafood consumption and blood mercury concentrations in adults aged ≥20y, 2007-2010
Nielsen SJ , Kit BK , Aoki Y , Ogden CL . Am J Clin Nutr 2014 99 (5) 1066-70 BACKGROUND: Seafood is part of a healthy diet, but seafood can also contain methyl mercury-a neurotoxin. OBJECTIVE: The objective was to describe seafood consumption in US adults and to explore the relation between seafood consumption and blood mercury. DESIGN: Seafood consumption, obtained from a food-frequency questionnaire, and blood mercury data were available for 10,673 adults who participated in the 2007-2010 NHANES-a cross-sectional nationally representative sample of the US population. Seafood consumption was categorized by type (fish or shellfish) and by frequency of consumption (0, 1-2, 3-4, or ≥5 times/mo). Linear trends in geometric mean blood mercury concentrations by frequency of seafood consumption were tested. Logistic regression analyses examined the odds of blood mercury concentrations ≥5.8 mug/L (as identified by the National Research Council) based on frequency of the specific type of seafood consumed (included in the model as a continuous variables) adjusted for sex, age, and race/Hispanic origin. RESULTS: In 2007-2010, 83.0% +/- 0.7% (+/-SE) of adults consumed seafood in the preceding month. In adults consuming seafood, the blood mercury concentration increased as the frequency of seafood consumption increased (P < 0.001). In 2007-2010, 4.6% +/- 0.39% of adults had blood mercury concentrations ≥5.8 mug/L. Results of the logistic regression on blood mercury concentrations ≥5.8 mug/L showed no association with shrimp (P = 0.21) or crab (P = 0.48) consumption and a highly significant positive association with consumption of high-mercury fish (adjusted OR per unit monthly consumption: 4.58; 95% CI: 2.44, 8.62; P < 0.001), tuna (adjusted OR: 1.14; 95% CI: 1.10, 1.17; P < 0.001), salmon (adjusted OR: 1.14; 95% CI: 1.09, 1.20; P < 0.001), and other seafood (adjusted OR: 1.12; 95% CI: 1.08, 1.15; P < 0.001). CONCLUSION: Most US adults consume seafood, and the blood mercury concentration is associated with the consumption of tuna, salmon, high-mercury fish, and other seafood. |
Impact of environmental tobacco smoke on children with asthma, United States, 2003-2010
Akinbami LJ , Kit BK , Simon AE . Acad Pediatr 2013 13 (6) 508-16 OBJECTIVE: Given widespread interventions to reduce environmental tobacco smoke (ETS) exposure and improve asthma control, we sought to assess the current impact of ETS exposure on children with asthma. METHODS: We analyzed 2003-2010 data for nonsmoking children aged 6 to 19 years with asthma from the National Health and Nutrition Examination Survey. Outcomes (sleep disturbance, missed school days, health care visits, activity limitation, and wheezing with exercise) were compared between ETS exposed children (serum cotinine levels 0.05 to 10 ng/mL) and unexposed children (<0.05 ng/mL) using ordinal regression adjusted for demographic characteristics. We also assessed whether associations were observable with low ETS exposure levels (0.05 to 1.0 ng/mL). RESULTS: Overall, 53.3% of children aged 6 to 19 years with asthma were ETS exposed. Age-stratified models showed associations between ETS exposure and most adverse outcomes among 6- to 11-year-olds, but not 12- to 19-year-olds. Even ETS exposure associated with low serum cotinine levels was associated with adverse outcomes for 6- to 11-year-olds. Race-stratified models for children aged 6 to 19 years showed an association between ETS exposure and missing school, health care visits, and activity limitation due to wheezing among non-Hispanic white children, and disturbed sleep among non-Hispanic white and Mexican children. Among non-Hispanic black children, there was no elevated risk between ETS exposure and the assessed outcomes: non-Hispanic black children had high rates of adverse outcomes regardless of ETS exposure. CONCLUSIONS: Among children with asthma 6 to 11 years of age, ETS exposure was associated with most adverse outcomes. Even ETS exposure resulting in low serum cotinine levels was associated with risks for young children with asthma. |
Reference values and factors associated with exhaled nitric oxide: U.S. youth and adults
Brody DJ , Zhang X , Kit BK , Dillon CF . Respir Med 2013 107 (11) 1682-91 BACKGROUND: Normative values for fractional exhaled nitric oxide (FeNO) and the associated co-factors are important in understanding the role of FeNO as a biomarker in airway disease. The objective of this study is to establish reference FeNO values for youth and adult asymptomatic, lifetime nonsmokers in the United States, and to describe the factors affecting these levels. METHODS: Cross-sectional analyses of the National Health and Nutrition Examination Survey from 2007 to 2010. The analytic sample consisted of 4718 youth and adults, ages 6-79 years, who were lifelong nonsmokers, and free of asthma, and other respiratory conditions and symptoms. Loge FeNO values were used as dependent variables to test associations of demographic and health related-covariates. Multivariable regression models were used to assess the independent effect and covariate-adjusted contribution of the factors. RESULTS: The geometric mean FeNO level was 8.3, 12.1, and 16.2 ppb for males 6-11, 12-19, and 20-79 years, and 8.4, 10.9, and 12.6 ppb for females in the corresponding age groups. Overall, FeNO levels increased with increasing age (p < 0.001), and height (p < 0.001). In all age groups, FeNO levels were positively associated with eosinophil counts, and with testing in the morning. Among youths 6-11 and 12-19 years, non-Hispanics whites had lower FeNO values than non-Hispanic blacks and Hispanic youths. No race-ethnic difference in FeNO levels was evident for adults 20-79 years. Among adolescents and adults, FeNO levels were higher for males than for females, controlling for all other factors. CONCLUSIONS: These reference values and associated attributes in youths and adults are useful in evaluating the role of FeNO in airway diseases. |
Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010
Kit BK , Fakhouri TH , Park S , Nielsen SJ , Ogden CL . Am J Clin Nutr 2013 98 (1) 180-8 BACKGROUND: Reducing sugar-sweetened beverage (SSB) consumption is a recommended strategy to promote optimal health. OBJECTIVE: The objective was to describe trends in SSB consumption among youth and adults in the United States. DESIGN: We analyzed energy intake from SSBs among 22,367 youth aged 2-19 y and 29,133 adults aged ≥20 y who participated in a 24-h dietary recall as part of NHANES, a nationally representative sample of the US population with a cross-sectional design, between 1999 and 2010. SSBs included soda, fruit drinks, sports and energy drinks, sweetened coffee and tea, and other sweetened beverages. Patterns of SSB consumption, including location of consumption and meal occasion associated with consumption, were also examined. RESULTS: In 2009-2010, youth consumed a mean (+/-SE) of 155 +/- 7 kcal/d from SSBs and adults consumed an age-adjusted mean (+/-SE) of 151 +/- 5 kcal/d from SSBs-a decrease from 1999 to 2000 of 68 kcal/d and 45 kcal/d, respectively (P-trend < 0.001 for each). In 2009-2010, SSBs contributed 8.0% +/- 0.4% and 6.9% +/- 0.2% of daily energy intake among youth and adults, respectively, which reflected a decrease compared with 1999-2000 (P-trend < 0.001 for both). Decreases in SSB consumption, both in the home and away from home and also with both meals and snacks, occurred over the 12-y study duration (P-trend < 0.01 for each). CONCLUSION: A decrease in SSB consumption among youth and adults in the United States was observed between 1999 and 2010. |
Physical activity and screen-time viewing among elementary school-aged children in the United States from 2009 to 2010
Fakhouri TH , Hughes JP , Brody DJ , Kit BK , Ogden CL . JAMA Pediatr 2013 167 (3) 223-9 OBJECTIVES: To describe the percentage of children who met physical activity and screen-time recommendations and to examine demographic differences. Recommendations for school-aged children include 60 minutes of daily moderate-to-vigorous physical activity and no more than 2 hours per day of screen-time viewing. DESIGN: Cross-sectional study. SETTING: Data from the 2009-2010 National Health and Nutrition Examination Survey, a representative sample of the US population. PARTICIPANTS: Analysis included 1218 children 6 to 11 years of age. MAIN EXPOSURES: Age, race/ethnicity, sex, income, family structure, and obesity status. MAIN OUTCOME MEASURES: Proxy-reported adherence to physical activity and screen-time recommendations, separately and concurrently. RESULTS: Based on proxy reports, overall, 70% of children met physical activity recommendations, and 54% met screen-time viewing recommendations. Although Hispanics were less likely to meet physical activity recommendations (adjusted odds ratio [aOR], 0.60 [95% CI, 0.38-0.95]), they were more likely to meet screen-time recommendations compared with non-Hispanic whites (aOR, 1.69 [95% CI, 1.18-2.43]). Only 38% met both recommendations concurrently. Age (9-11 years vs 6-8 years: aOR, 0.57 [95% CI, 0.38-0.85]) and obesity (aOR, 0.53 [95% CI, 0.38-0.73]) were inversely associated with concurrent adherence to both recommendations. CONCLUSIONS: Fewer than 4 in 10 children met both physical activity and screen-time recommendations concurrently. The prevalence of sedentary behavior was higher in older children. Low levels of screen-time viewing may not necessarily predict higher levels of physical activity. |
US prevalence and trends in tobacco smoke exposure among children and adolescents with asthma
Kit BK , Simon AE , Brody DJ , Akinbami LJ . Pediatrics 2013 131 (3) 407-14 OBJECTIVE: To examine exposure to tobacco smoke products (TSPs), environmental tobacco smoke (ETS), and in-home smoke among youth with asthma in the United States. METHODS: Nationally representative, cross-sectional data from 2250 youth aged 4 to 19 years with current asthma in the 1988-1994, 1999-2004, and 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed. Outcomes were use of TSPs (serum cotinine level >10 ng/mL or self-reported recent use of cigarettes, cigars, or pipes) and, among non-TSP users, ETS exposure (serum cotinine ≥0.05 ng/mL) and in-home smoke exposure (reported). Multiple logistic regression analyses assessed the associations between the outcomes and age, gender, race/ethnicity, and family income. RESULTS: Among adolescents (aged 12-19 years) with asthma in 2005-2010, 17.3% reported TSP use. Among youth (aged 4-19 years) with asthma who did not use TSPs, 53.2% were exposed to ETS and 17.6% had in-home smoke exposure. Among low-income youth, 70.1% and 28.1% had exposure to ETS and in-home smoke, respectively. After controlling for sociodemographic factors, higher prevalence of exposure to ETS and in-home smoke persisted among low-income youth. Between 1988-1994 and 2005-2010, there was a decline in ETS and in-home smoke exposure (both P < .001). CONCLUSIONS: ETS exposure among youth with asthma declined between 1988-1994 and 2005-2010, but a majority remained exposed in 2005-2010, with higher exposure among low-income youth. More than 1 in 6 youth with asthma in 2005-2010 were exposed to in-home smoke and a similar portion of adolescents used TSPs. |
Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis
Flegal KM , Kit BK , Orpana H , Graubard BI . JAMA 2013 309 (1) 71-82 IMPORTANCE: Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting. OBJECTIVE: To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population. DATA SOURCES: PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions. STUDY SELECTION: Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths. DATA EXTRACTION: Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking). RESULTS: Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured. CONCLUSIONS AND RELEVANCE: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons. |
Trends in lipids and lipoproteins in US adults, 1988-2010
Carroll MD , Kit BK , Lacher DA , Shero ST , Mussolino ME . JAMA 2012 308 (15) 1545-54 CONTEXT: Serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) contribute to atherosclerosis and its clinical consequences. Between the periods 1988-1994 and 1999-2002, mean TC and mean LDL-C declined in adults. During this time, there was an increase in the percentage of adults receiving lipid-lowering medications. Geometric mean triglyceride levels increased but mean high-density lipoprotein cholesterol (HDL-C) remained unchanged. OBJECTIVE: To examine trends in serum lipids in adults between 1988 and 2010. DESIGN, SETTING, AND PARTICIPANTS: Three distinct US cross-sectional National Health and Nutrition Examination Surveys, 1988-1994 (n = 16,573), 1999-2002 (n = 9471), and 2007-2010 (n = 11,766). MAIN OUTCOME MEASURES: Mean TC, LDL-C, HDL-C, non-HDL-C, and geometric mean triglyceride levels and the prevalence of lipid-lowering medication use. RESULTS: Mean TC declined from 206 (95% CI, 205-207) mg/dL in 1988-1994 to 196 (95% CI, 195-198) mg/dL in 2007-2010 (P <.001 for linear trend); mean LDL-C declined from 129 (95% CI, 127-130) mg/dL to 116 (95% CI, 114-117) mg/dL (P <.001 for linear trend). Mean non-HDL-C declined from 155 (95% CI, 153-157) mg/dL in 1988-1994 to 144 (95% CI, 143-145) mg/dL in 2007-2010 (P <.001 for linear trend). Mean HDL-C increased from 50.7 (95% CI, 50.0-51.0) mg/dL during 1988-1994 to 52.5 (95% CI, 51.8-53.2) mg/dL in 2007-2010 (P =.001 for linear trend). Geometric mean serum triglyceride levels increased from 118 (95% CI, 114-121) mg/dL in 1988-1994 to 123 (95% CI, 119-127) mg/dL in 1999-2002 and decreased to 110 (95% CI, 107-113) mg/dL in 2007-2010 (P <.001 for quadratic trend). The prevalence of lipid-lowering medication use increased from 3.4% (95% CI, 2.9%-3.9%) in 1988-1994 to 15.5% (95% CI, 14.7%-16.3%) in 2007-2010 (P <.001 for linear trend). Among adults not receiving lipid-lowering medications, trends in lipids were similar to those reported for adults overall. Among obese adults, mean TC, non-HDL-C, LDL-C, and geometric mean triglycerides declined between 1988 and 2010. CONCLUSION: Between 1988 and 2010, favorable trends in lipid levels have occurred among adults in the United States. |
Trends in serum lipids among US youths aged 6 to 19 years, 1988-2010
Kit BK , Carroll MD , Lacher DA , Sorlie PD , DeJesus JM , Ogden C . JAMA 2012 308 (6) 591-600 CONTEXT: For more than 20 years, primary prevention of coronary heart disease has included strategies intended to improve overall serum lipid concentrations among youths. OBJECTIVE: To examine trends in lipid concentrations among youths from 1988-1994 through 2007-2010. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of serum lipid concentrations among 16,116 youths aged 6 to 19 years who participated in the nationally representative National Health and Nutrition Examination Survey during 3 time periods: 1988-1994, 1999-2002, and 2007-2010. MAIN OUTCOME MEASURES: Among all youths, mean serum total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C); and among adolescents only, low-density lipoprotein cholesterol (LDL-C) and geometric mean triglyceride levels. Trends in adverse lipid concentrations are reported for TC levels of 200 mg/dL and greater, non-HDL-C levels of 145 mg/dL and greater, HDL-C levels of less than 40 mg/dL, LDL-C levels of 130 mg/dL and greater, and triglyceride levels of 130 mg/dL and greater. RESULTS: Among youths aged 6 to 19 years between 1988-1994 and 2007-2010, there was a decrease in mean TC (from 165 mg/dL [95% CI, 164-167] to 160 mg/dL [95% CI, 158-161]; P < .001) and a decrease in the prevalence of elevated TC (from 11.3% [95% CI, 9.8%-12.7%] to 8.1% [95% CI, 6.7%-9.5%]; P = .002). Mean HDL-C significantly increased between 1988-1994 and 2007-2010, but the prevalence of low HDL-C did not change. Mean non-HDL-C and prevalence of elevated non-HDL-C both significantly decreased over the study period. In 2007-2010, 22% (95% CI, 20.3%-23.6%) of youths had either a low HDL-C level or high non-HDL-C, which was lower than the 27.2% (95% CI, 24.6%-29.7%) in 1988-1994 (P = .001). Among adolescents (aged 12-19 years) between 1988-1994 and 2007-2010, there was a decrease in mean LDL-C (from 95 mg/dL [95% CI, 92-98] to 90 mg/dL [95% CI, 88-91]; P = .003) and a decrease in geometric mean triglycerides (from 82 mg/dL [95% CI, 78-86] to 73 mg/dL [95% CI, 70-76]; P < .001). Prevalence of elevated LDL-C and triglycerides between 1988-1994 and 2007-2010 also significantly decreased. CONCLUSIONS: Between 1988-1994 and 2007-2010, a favorable trend in serum lipid concentrations was observed among youths in the United States but almost 1 in 10 had elevated TC in 2007-2010. |
Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010
Flegal KM , Carroll MD , Kit BK , Ogden CL . JAMA 2012 307 (5) 491-7 CONTEXT: Between 1980 and 1999, the prevalence of adult obesity (body mass index [BMI] ≥30) increased in the United States and the distribution of BMI changed. More recent data suggested a slowing or leveling off of these trends. OBJECTIVE: To estimate the prevalence of adult obesity from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) and compare adult obesity and the distribution of BMI with data from 1999-2008. DESIGN, SETTING, AND PARTICIPANTS: NHANES includes measured heights and weights for 5926 adult men and women from a nationally representative sample of the civilian noninstitutionalized US population in 2009-2010 and for 22,847 men and women in 1999-2008. MAIN OUTCOME MEASURES: The prevalence of obesity and mean BMI. RESULTS: In 2009-2010 the age-adjusted mean BMI was 28.7 (95% CI, 28.3-29.1) for men and also 28.7 (95% CI, 28.4-29.0) for women. Median BMI was 27.8 (interquartile range [IQR], 24.7-31.7) for men and 27.3 (IQR, 23.3-32.7) for women. The age-adjusted prevalence of obesity was 35.5% (95% CI, 31.9%-39.2%) among adult men and 35.8% (95% CI, 34.0%-37.7%) among adult women. Over the 12-year period from 1999 through 2010, obesity showed no significant increase among women overall (age- and race-adjusted annual change in odds ratio [AOR], 1.01; 95% CI, 1.00-1.03; P=.07), but increases were statistically significant for non-Hispanic black women (P = .04) and Mexican American women (P=.046). For men, there was a significant linear trend (AOR, 1.04; 95% CI, 1.02-1.06; P<.001) over the 12-year period. For both men and women, the most recent 2 years (2009-2010) did not differ significantly (P=.08 for men and P=.24 for women) from the previous 6 years (2003-2008). Trends in BMI were similar to obesity trends. CONCLUSION: In 2009-2010, the prevalence of obesity was 35.5% among adult men and 35.8% among adult women, with no significant change compared with 2003-2008. |
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