Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 79 Records) |
Query Trace: Ogden CL [original query] |
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Prevalence of diabetes by BMI: China Nutrition and Health Surveillance (2015-2017) and U.S. National Health and Nutrition Examination Survey (2015-2018)
Yu D , Martin CB , Fryar CD , Hales CM , Eberhardt MS , Carroll MD , Zhao L , Ogden CL . AJPM Focus 2024 3 (3) 100215 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. |
Reasons for nonparticipation in the Special Supplemental Nutrition Program For Women, Infants, And Children
Terry AL , Wambogo E , Scanlon KS , Fryar CD , Abelev M , Reat A , Ogden CL . JAMA Pediatr 2024 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 |
Differences in intakes of select nutrients by urbanization level in the U.S. population 2 years and older, NHANES 2013-2018
Wambogo EA , Ansai N , Herrick KA , Reedy J , Hales CM , Ogden CL . J Nutr 2023 BACKGROUND: Differences in nutrient intakes by urbanization level in the U.S. is not well understood. OBJECTIVE: Describe, by urbanization level: 1) intake of protein, fiber, percent of energy from added sugars (AS) and saturated fat (SF), calcium, iron, potassium, sodium, and vitamin D; 2) the percent of the population meeting nutrient recommendations. METHODS: 24-hour dietary recalls from 23,107 participants aged 2 years and over from the 2013-2018 National Health and Nutrition Examination Surveys were analyzed. Usual intakes were estimated, and linear regression models adjusted for age, sex, race and Hispanic origin, and whether family income met the 130% threshold examined intake differences by urbanization levels-large urban areas (LUA), small to medium metro areas (SMMA), and rural areas (RA). RESULTS: A small percentage of the population met the nutrient recommendations, except for protein (92.8%) and iron (70.5%). A higher percentage of the population met recommendations than SMMA and RA for fiber (11.8% vs. 8.1% and 5.3%, p<0.001), AS (40.2% vs. 33.4% and 31.3%, p<0.001), SF (26.8% vs. 18.2% and 20.1%, p<0.001), and potassium (31.5% vs. 25.5% and 22.0%, p<0.001). Mean protein intake were also higher in LUA than RA (80.0g vs. 77.7g, p=0.003) and fiber intake higher in LUA than SMMA (16.5g vs. 15.9g, p=0.01) and RA (16.5g vs. 15.2g, p=0.001). Additionally, contributions to energy intake were lower in LUA than SMMA for AS (11.3% v 12.0%, p<0.001) and SF (11.5% v 11.7%, p<0.001), and for LUA than RA for AS (11.3% v 12.9%, p<0.001) and SF (11.5% v 11.8%, p<0.001). CONCLUSIONS: Rural areas had some markers of poorer diet quality-lower protein and fiber intake and higher AS intake-compared to large urban areas, and these differences persisted in adjusted regression models. These results may inform public health efforts to address health disparities by urbanization levels in the U.S. |
Federal housing assistance and chronic disease among US adults, 2005-2018
Kim C , Rossen LM , Stierman B , Garrison V , Hales CM , Ogden CL . Prev Chronic Dis 2023 20 E111 INTRODUCTION: Housing insecurity is associated with poor health outcomes. Characterization of chronic disease outcomes among adults with and without housing assistance would enable housing programs to better understand their population's health care needs. METHODS: We used National Health and Nutrition Examination Survey (NHANES) data from 2005 through 2018 linked to US Department of Housing and Urban Development (HUD) administrative records to estimate the prevalence of obesity, diabetes, and hypertension and to assess the independent associations between housing assistance and chronic conditions among adults receiving HUD assistance and HUD-assistance-eligible adults not receiving HUD assistance at the time of their NHANES examination. We estimated propensity scores to adjust for potential confounders among linkage-eligible adults who had an income-to-poverty ratio less than 2 and were not receiving HUD assistance. Sensitivity analysis used 2013-2018 NHANES cycles to account for disability status. RESULTS: Adults not receiving HUD assistance had a significantly lower adjusted prevalence of obesity (42.1%; 95% CI, 40.4%-43.8%) compared with adults receiving HUD assistance (47.5%; 95% CI, 44.8%-50.3%), but we found no differences for diabetes and hypertension. We found significant associations between housing assistance and obesity (adjusted odds ratio = 1.29; 95% CI, 1.12-1.47), but these were not significant in the sensitivity analysis with and without controlling for disability status. We found no significant associations between housing assistance and diabetes or hypertension. CONCLUSION: Based on data from a cross-sectional survey, we observed a higher prevalence of obesity among adults with HUD assistance compared with HUD-assistance-eligible adults without HUD assistance. Results from this study can help inform research on understanding the prevalence of chronic disease among adults with HUD assistance. |
CDC extended BMI-for-age percentiles versus percent of the 95th percentile
Ogden CL , Freedman DS , Hales CM . Pediatrics 2023 152 (3) In December 2022, the Centers for Disease Control and Prevention (CDC) released Extended BMI-for-age growth charts1,2 for children and adolescents with high BMI values. These charts extend to a BMI of 60 and add 4 growth curves (98th, 99th, 99.9th, and 99.99th percentiles). Obesity among children and adolescents is defined as BMI ≥95th percentile of BMI-for-age and severe obesity as BMI ≥120% of the 95th percentile or ≥35.3 The recent American Academy of Pediatrics guideline for the treatment of obesity recommends using percentages of the 95th percentile of BMI-for-age to indicate different levels of severe obesity.4 This analysis compares CDC extended BMI-for-age percentiles with 120% and 140% of the 95th percentile and illustrates the differences between the prevalence of US children and adolescents 2 to 19 years of age with a BMI ≥ extended 98th percentile using the newly defined curve and those ≥120% of the 95th percentile using 2017 to March 2020 National Health and Nutritional Examination (NHANES) data. |
Interpreting Weight, Height, and Body Mass Index Percentiles in the US Centers for Disease Control and Prevention Growth Charts
Akinbami L , Ogden CL . JAMA Pediatr 2022 176 (4) 423-424 A recent publication1 presented challenges in discussing CDC growth charts with patients and families. We would like to provide some clarifying points. | | Growth charts do not show individual trajectories but a population average. Therefore, back-to-birthweight monitoring should be separate from growth chart conversations except to provide reassurance that once birthweight is regained, a child will tend to grow along a trajectory. Additionally, WHO growth charts are recommended from birth to age 22. In contrast to the CDC charts (recommended for ages 2-19), these WHO charts are a growth standard based on children selected on several factors, including optimal feeding patterns. |
Added Sugars Intake among US Infants and Toddlers
Herrick KA , Fryar CD , Hamner HC , Park S , Ogden CL . J Acad Nutr Diet 2020 120 (1) 23-32 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. |
Dietary contributions of food outlets by urbanization level in the US population 2 years and older, NHANES 2013-2018
Ansai N , Wambogo EA , Herrick KA , Zimmer M , Reedy J , Hales CM , Ogden CL . Am J Clin Nutr 2023 117 (5) 946-954 BACKGROUND: Differences in food access, availability, affordability, and dietary intake are influenced by the food environment, which includes outlets where foods are obtained. These differences between food outlets within rural and urban food environments in the US are not well understood. OBJECTIVE: The aim of this analysis was to describe the contribution of foods and beverages from six outlets - grocery stores, convenience stores, full-service restaurants, quick-service restaurants, schools, and other outlets - to total energy intake and Healthy Eating Index (HEI)-2015 scores in the US population, by urbanization level (non-metropolitan statistical areas (MSA), small to medium MSA, and large MSA). DESIGN: Data were from the National Health and Nutrition Examination Survey 2013-2018. Dietary intake from one 24-hour dietary recall was analyzed by the outlet where a food or beverage was obtained and by urbanization. Linear regression, adjusted for sex, age, race and Hispanic origin, and family income, was used to predict the contribution of each food outlet to total energy intake and HEI-2015 total and component scores by urbanization level. RESULTS: During 2013-2018, foods and beverages from grocery stores, quick-service, and full-service restaurants provided 62.1%, 15.1% and 8.5% of energy intake, respectively. The percent of energy intake from full- and quick-service restaurants increased with increasing urbanization level. HEI-2015 total scores increased with increasing urbanization level overall (48.1 non-MSAs, 49.2 small to medium MSAs, and 51.3 large MSAs), for grocery stores (46.7 non-MSAs, 48.0 small to medium MSAs, and 50.6 large MSAs), and for quick-service restaurants (35.8 non-MSAs, 36.3 small to medium MSAs, and 37.5 large MSAs). CONCLUSION: Grocery stores and restaurants were the largest contributors of energy intake in urban and rural areas. Diet quality improved with increasing urbanization overall and for grocery stores and quick-service restaurants. |
Trends in food consumption among children aged 1-4 years by participation in the Special Supplemental Nutrition Program for Women, Infants, and Children, United States, 2005-2018
Fryar CD , Wambogo EA , Scanlon KS , Terry AL , Ogden CL . J Nutr 2023 153 (3) 839-847 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. |
Trends in obesity disparities during childhood
Ogden CL , Martin CB , Freedman DS , Hales CM . Pediatrics 2022 150 (2) In this issue of Pediatrics, Cunningham et al1 explore obesity incidence trends in school-aged children from kindergarten through fifth grade in 2 cohorts of the Early Childhood Longitudinal Study (ECLS). The earlier cohort was followed from 1998 to 2004 and the later cohort from 2010 to 2016. The ECLS results show an increase in incidence of obesity in the 2010 cohort compared with the 1998 cohort. Moreover, among children who entered kindergarten without obesity, 29% more non-Hispanic Black children developed obesity by fifth grade in the later cohort compared with the earlier one, whereas obesity incidence remained unchanged or decreased in other race and ethnicity groups. |
The contribution of discrete vegetables, mixed dishes, and other foods to total vegetable consumption: US ages 2 years and over, 2017-2018
Wambogo EA , Ansai N , Ahluwalia N , Ogden CL . J Acad Nutr Diet 2022 122 (11) 2115-2126 e2 BACKGROUND: The 2020-2025 Dietary Guidelines for Americans (DGAs) recommend intake of a variety of vegetables, including dark green, red and orange, starchy, and other vegetables. OBJECTIVES: This study aims to describe sociodemographic differences in the contribution of different categories of vegetables, and the form in which they are consumed, i.e., discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetables intake on a given day. DESIGN: This is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: /Setting: This study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls. MAIN OUTCOME MEASURES: Serving equivalents of vegetables from 20 discrete categories of vegetables, and from mixed dishes and other foods as a percentage of total vegetables. STATISTICAL ANALYSES: Pairwise differences by age, sex, and race and Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income examined using orthogonal polynomials. RESULTS: Mean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake and the contribution increased with age in adults, and with increasing family income. The top five discrete vegetable contributors were other vegetables and combinations, French fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Non-starchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income. CONCLUSIONS: Discrete vegetables only contributed 55.2% of total vegetables intake, and the top sources were not varied, three of them potato-based, which may explain the reported low vegetables intake, relative to the DGAs. More than one-third of vegetables consumed were non-starchy discrete vegetables, many of which are high in vitamins. Non-starchy discrete vegetable intake was higher in adults than youth and increased with family income. |
Body fat differences among US youth aged 8-19 by race and Hispanic origin, 2011-2018
Martin CB , Stierman B , Yanovski JA , Hales CM , Sarafrazi N , Ogden CL . Pediatr Obes 2022 17 (7) e12898 BACKGROUND: The association between body mass index (BMI) and adiposity differs by race/ethnicity. OBJECTIVE: To examine differences in adiposity by race/Hispanic origin among US youth and explore how those differences relate to differences in BMI using the most recent national data, including non-Hispanic Asian youth. METHODS: Weight, height and DXA-derived fat mass index (FMI) and percentage body fat (%BF) from 6923 youth 8-19years in the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were examined. Age-adjusted mean BMI, FMI and %BF were reported. Sex-specific linear regression models predicting %BF and FMI were adjusted for age, BMI category and BMI category*race/Hispanic origin interaction. RESULTS: %BF was highest among Hispanic males (28.2%) and females (35.7%). %BF was lower among non-Hispanic Black (23.9%) compared with non-Hispanic White (26.0%) and non-Hispanic Asian (26.6%) males. There was no difference between non-Hispanic Black females (32.7%) and non-Hispanic White (33.2%) or non-Hispanic Asian (32.7%) females. FMI was higher among Hispanic youth compared with non-Hispanic White youth. Among youth with underweight/healthy weight, predicted %BF and FMI were lower among non-Hispanic Black males (-2.8%; -0.5) and females (-2.0%; -0.3), compared with non-Hispanic White youth, and higher among Hispanic males (0.9%; 0.2) and females (2.0%; 0.5), while %BF but not FMI was higher among non-Hispanic Asian males (1.3%) and females (1.4%). Among females with obesity, non-Hispanic Asian females had lower %BF (-2.3%) and FMI (-1.7) than non-Hispanic White females. CONCLUSIONS: Differences in %BF and FMI by race/Hispanic origin were not consistent by BMI category among US youth in 2011-2018. |
Use of prescription medications associated with weight gain among US adults, 1999-2018: A nationally representative survey
Hales CM , Gu Q , Ogden CL , Yanovski SZ . Obesity (Silver Spring) 2021 30 (1) 229-239 OBJECTIVE: This study aimed to evaluate trends in the use of obesogenic medications among adults. METHODS: Cross-sectional data on adults aged ≥20 years are from the 1999 to 2018 National Health and Nutrition Examination Survey (n = 52,340). Obesogenic medications were defined according to the 2015 Endocrine Society guidelines on the pharmacological management of obesity. Weight status was categorized according to BMI. Trends in prior 30-day use were evaluated. RESULTS: In NHANES 2017-2018, 20.3% of US adults used an obesogenic medication. Beta-blockers (9.8%) and antidiabetics (5.7%) were the most common; antipsychotics (1.0%) were the least common. Most common indications were disorders of glucose metabolism, hypertension, neuralgia or neuritis, heart disease, and musculoskeletal pain and/or inflammation. From 1999 to 2018, the proportional use of obesogenic medications increased for anticonvulsants (34.4% to 55.0%) but decreased for antidepressants (32.1% to 18.8%), antidiabetics (82.9% to 52.5%), and beta-blockers (83.9% to 80.7%). The proportional use of obesogenic medications was not associated with weight status, except for antipsychotics. CONCLUSIONS: Use of obesogenic medications was common. Differences in the proportional use of obesogenic medication may reflect changing availability of obesogenic versus nonobesogenic medications over time. The decision to prescribe a nonobesogenic alternative, if one exists, is guided by weighing the risks and benefits of available treatments. |
Changes in adiposity among children and adolescents in the United States, 1999-2006 to 2011-2018
Stierman B , Ogden CL , Yanovski JA , Martin CB , Sarafrazi N , Hales CM . Am J Clin Nutr 2021 114 (4) 1495-1504 BACKGROUND: Data from the NHANES indicate that BMI has increased in some subgroups of children and adolescents in the United States over the past 20 y; however, BMI is an indirect measure of body fatness. OBJECTIVES: We assessed changes in DXA-derived measures of adiposity in a nationally representative population of US children and adolescents aged 8-19 y from 1999-2006 to 2011-2018. METHODS: Using data from the NHANES, we compared the means and distributions of DXA-derived percentage body fat (%BF) and fat mass index (FMI; fat mass/height2 in kg/m2) between 1999-2006 (n = 10,231) and 2011-2018 (n = 6923) among males and females by age group, race and Hispanic origin, and BMI categories. Estimates were standardized by age and race and Hispanic origin. RESULTS: From 1999-2006 to 2011-2018, mean %BF increased from 25.6% to 26.3% (change in %BF: 0.7%; 95% CI: 0.2%, 1.2%; P < 0.01) among all males, whereas mean %BF increased from 33.0% to 33.7% (change in %BF: 0.7%; 95% CI: 0.2%, 1.2%; P = 0.01) and mean FMI increased from 7.7 to 8.0 fat mass kg/m2 (change in FMI: 0.3 fat mass kg/m2; 95% CI: 0.0, 0.6 fat mass kg/m2; P = 0.02) among all females. Changes were not consistent across all age, race and Hispanic origin, and BMI categories. Both %BF and FMI increased among Mexican-American children and adolescents, but not other race and Hispanic origin groups. CONCLUSIONS: Among US children and adolescents, DXA-derived measures of adiposity increased from 1999-2006 to 2011-2018, albeit not consistently in every age, race and Hispanic origin, and BMI subgroup. These data reinforce the need to consider other measures, besides BMI categories, when studying adiposity in children and adolescents. |
Association of usual sodium intake with obesity among US children and adolescents, NHANES 2009-2016
Zhao L , Ogden CL , Yang Q , Jackson SL , Loria CM , Galuska DA , Wiltz JL , Merritt R , Cogswell ME . Obesity (Silver Spring) 2021 29 (3) 587-594 OBJECTIVE: The purpose of this study was to investigate the association of sodium intake with obesity in US children and adolescents. METHODS: Cross-sectional data were analyzed for 9,026 children and adolescents in the National Health and Nutrition Examination Survey (NHANES) 2009-2016. Usual sodium intake was estimated from 24-hour dietary recalls using a measurement error model. Logistic regression was used to assess the association of sodium intake with overweight/obesity, obesity, and central obesity (waist to height ratio [WtHR] ≥ 0.5; waist circumferences (WC) ≥ age- and sex-specific 90th percentile). RESULTS: Mean (SE) sodium intake was 3,010 (9) and 3,404 (20) mg/d for children and adolescents, respectively. The adjusted odds ratio (AOR) comparing Q4 versus Q1 (87.5th vs. 12.5th percentile of sodium intake) among children was 1.98 (95% CI: 1.19-3.28) for overweight/obesity, 2.20 (1.30-3.73) for obesity, 2.10 (1.12-3.95) for WC ≥ 90th percentile, and 1.68 (0.95-2.97) for WtHR ≥ 0.5, adjusting for demographics, energy, and sugar-sweetened beverage intake. Among adolescents, AOR was 1.81 (0.98-3.37) for overweight/obesity, 1.71 (0.82-3.56) for obesity, 1.62 (0.71-3.66) for WC ≥ 90th percentile, and 1.73 (0.85-3.50) for WtHR ≥ 0.5. CONCLUSIONS: Sodium intake was positively associated with overweight/obesity, obesity, and central obesity among US children independent of energy and SSB intake, but the association did not reach significance among adolescents. |
A method for calculating BMI z-scores and percentiles above the 95(th) percentile of the CDC growth charts
Wei R , Ogden CL , Parsons VL , Freedman DS , Hales CM . Ann Hum Biol 2020 47 (6) 1-8 BACKGROUND: The 2000 CDC growth charts are based on national data collected between 1963 and 1994 and include a set of selected percentiles between the 3(rd) and 97(th) and LMS parameters that can be used to obtain other percentiles and associated z-scores. Obesity is defined as a sex- and age-specific body mass index (BMI) at or above the 95(th) percentile. Extrapolating beyond the 97(th) percentile is not recommended and leads to compressed z-score values. AIM: This study attempts to overcome this limitation by constructing a new method for calculating BMI distributions above the 95(th) percentile using an extended reference population. SUBJECTS AND METHODS: Data from youth at or above the 95(th) percentile of BMI-for-age in national surveys between 1963 and 2016 were modelled as half-normal distributions. Scale parameters for these distributions were estimated at each sex-specific 6-month age-interval, from 24 to 239 months, and then smoothed as a function of age using regression procedures. RESULTS: The modelled distributions above the 95(th) percentile can be used to calculate percentiles and non-compressed z-scores for extreme BMI values among youth. CONCLUSION: This method can be used, in conjunction with the current CDC BMI-for-age growth charts, to track extreme values of BMI among youth. |
Trends in obesity prevalence by race and Hispanic origin - 1999-2000 to 2017-2018
Ogden CL , Fryar CD , Martin CB , Freedman DS , Carroll MD , Gu Q , Hales CM . JAMA 2020 324 (12) 1208-1210 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. |
The association of nativity/length of residence and cardiovascular disease risk factors in the United States
Fryar CD , Fakhouri TH , Carroll MD , Frenk SM , Ogden CL . Prev Med 2019 130 105893 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. |
Trends in preventive visits among U.S. youth where weight and height were recorded: 2005-2016
Santo L , Rui P , Hales CM , Arem H , Ogden CL . Am J Prev Med 2019 57 (5) 716-717 In the U.S., 18.5% of U.S. youth aged 2–19 years have obesity.1 Since 2003, the American Academy of Pediatrics has recommended measurement of weight and height at each preventive visit for all children and adolescents to screen for obesity; current guidelines apply to those aged ≥2 years.2–4 | | This study analyzed trends and differences by age in preventive visits of U.S. youth aged 2–19 years to pediatricians and family medicine physicians in which weight and height were recorded between 2005 and 2016. |
Comparisons of self-reported and measured height and weight, BMI, and obesity prevalence from national surveys: 1999-2016
Flegal KM , Ogden CL , Fryar C , Afful J , Klein R , Huang DT . Obesity (Silver Spring) 2019 27 (10) 1711-1719 OBJECTIVE: The aim of this study was to compare national estimates of self-reported and measured height and weight, BMI, and obesity prevalence among adults from US surveys. METHODS: Self-reported height and weight data came from the National Health and Nutrition Examination Survey (NHANES), the National Health Interview Survey, and the Behavioral Risk Factor Surveillance System for the years 1999 to 2016. Measured height and weight data were available from NHANES. BMI was calculated from height and weight; obesity was defined as BMI >/= 30. RESULTS: In all three surveys, mean self-reported height was higher than mean measured height in NHANES for both men and women. Mean BMI from self-reported data was lower than mean BMI from measured data across all surveys. For women, mean self-reported weight, BMI, and obesity prevalence in the National Health Interview Survey and Behavioral Risk Factor Surveillance System were lower than self-report in NHANES. The distribution of BMI was narrower for self-reported than for measured data, leading to lower estimates of obesity prevalence. CONCLUSIONS: Self-reported height, weight, BMI, and obesity prevalence were not identical across the three surveys, particularly for women. Patterns of misreporting of height and weight and their effects on BMI and obesity prevalence are complex. |
Distance and percent distance from median BMI as alternatives to BMI z-score
Freedman DS , Woo JG , Ogden CL , Xu JH , Cole TJ . Br J Nutr 2019 124 (5) 1-25 Body mass index z-score (BMIz) based on the CDC growth charts is widely used, but it is inaccurate above the 97th percentile. We explored the performance of alternative metrics based on the absolute distance or % distance of a child's BMI from the median BMI for sex and age. We used longitudinal data from 5628 children who were first examined < 12 y to compare the tracking of three BMI metrics: distance from median, % distance from median, and % distance from median on a log scale. We also explored the effects of adjusting these metrics for age differences in the distribution of BMI. The intra-class correlation coefficient (ICC) was used to compare tracking of the metrics. |
Association of usual 24-h sodium excretion with measures of adiposity among adults in the United States: NHANES, 2014
Zhao L , Cogswell ME , Yang Q , Zhang Z , Onufrak S , Jackson SL , Chen TC , Loria CM , Wang CY , Wright JD , Terry AL , Merritt R , Ogden CL . Am J Clin Nutr 2019 109 (1) 139-147 Background: Both excessive sodium intake and obesity are risk factors for hypertension and cardiovascular disease. The association between sodium intake and obesity is unclear, with few studies assessing sodium intake using 24-h urine collection. Objectives: Our objective was to assess the association between usual 24-h sodium excretion and measures of adiposity among US adults. Methods: Cross-sectional data were analyzed from a sample of 730 nonpregnant participants aged 20-69 y who provided up to 2 complete 24-h urine specimens in the NHANES 2014 and had data on overweight or obesity [body mass index (kg/m2) >/=25] and central adiposity [waist circumference (WC): >88 cm for women, >102 cm for men]. Measurement error models were used to estimate usual sodium excretion, and multiple linear and logistic regression models were used to assess its associations with measures of adiposity, adjusting for sociodemographic, health, and dietary variables [i.e., energy intake or sugar-sweetened beverage (SSB) intake]. All analyses accounted for the complex survey sample design. Results: Unadjusted mean +/- SE usual sodium excretion was 3727 +/- 43.5 mg/d and 3145 +/- 55.0 mg/d among participants with and without overweight/obesity and 3653 +/- 58.1 mg/d and 3443 +/- 35.3 mg/d among participants with or without central adiposity, respectively. A 1000-mg/d higher sodium excretion was significantly associated with 3.8-units higher BMI (95% CI: 2.8, 4.8) and a 9.2-cm greater WC (95% CI: 6.9, 11.5 cm) adjusted for covariates. Compared with participants in the lowest quartile of sodium excretion, the adjusted prevalence ratios in the highest quartile were 1.93 (95% CI: 1.69, 2.20) for overweight/obesity and 2.07 (95% CI: 1.74, 2.46) for central adiposity. The associations also were significant when adjusting for SSBs, instead of energy, in models. Conclusions: Higher usual sodium excretion is associated with overweight/obesity and central adiposity among US adults. |
Differences in obesity prevalence by demographic characteristics and urbanization level among adults in the United States, 2013-2016
Hales CM , Fryar CD , Carroll MD , Freedman DS , Aoki Y , Ogden CL . JAMA 2018 319 (23) 2419-2429 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. |
Differences in obesity prevalence by demographics and urbanization in US children and adolescents, 2013-2016
Ogden CL , Fryar CD , Hales CM , Carroll MD , Aoki Y , Freedman DS . JAMA 2018 319 (23) 2410-2418 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. |
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. |
Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016
Hales CM , Fryar CD , Carroll MD , Freedman DS , Ogden CL . JAMA 2018 319 (16) 1723-1725 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. |
Prevalence of obesity among youths by household income and education level of head of household - United States 2011-2014
Ogden CL , Carroll MD , Fakhouri TH , Hales CM , Fryar CD , Li X , Freedman DS . MMWR Morb Mortal Wkly Rep 2018 67 (6) 186-189 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). |
Disparities in plain, tap and bottled water consumption among US adults: National Health and Nutrition Examination Survey (NHANES) 2007-2014
Rosinger AY , Herrick KA , Wutich AY , Yoder JS , Ogden CL . Public Health Nutr 2018 21 (8) 1-10 OBJECTIVE: Differences in bottled v. tap water intake may provide insights into health disparities, like risk of dental caries and inadequate hydration. We examined differences in plain, tap and bottled water consumption among US adults by sociodemographic characteristics. DESIGN: Cross-sectional analysis. We used 24 h dietary recall data to test differences in percentage consuming the water sources and mean intake between groups using Wald tests and multiple logistic and linear regression models. SETTING: National Health and Nutrition Examination Survey (NHANES), 2007-2014. SUBJECTS: A nationally representative sample of 20 676 adults aged >/=20 years. RESULTS: In 2011-2014, 81.4 (se 0.6) % of adults drank plain water (sum of tap and bottled), 55.2 (se 1.4) % drank tap water and 33.4 (se 1.4) % drank bottled water on a given day. Adjusting for covariates, non-Hispanic (NH) Black and Hispanic adults had 0.44 (95 % CI 0.37, 0.53) and 0.55 (95 % CI 0.45, 0.66) times the odds of consuming tap water, and consumed B=-330 (se 45) ml and B=-180 (se 45) ml less tap water than NH White adults, respectively. NH Black, Hispanic and adults born outside the fifty US states or Washington, DC had 2.20 (95 % CI 1.79, 2.69), 2.37 (95 % CI 1.91, 2.94) and 1.46 (95 % CI 1.19, 1.79) times the odds of consuming bottled water than their NH White and US-born counterparts. In 2007-2010, water filtration was associated with higher odds of drinking plain and tap water. CONCLUSIONS: While most US adults consumed plain water, the source (i.e. tap or bottled) and amount differed by race/Hispanic origin, nativity status and education. Water filters may increase tap water consumption. |
Prevalence of obesity among adults, by household income and education - United States, 2011-2014
Ogden CL , Fakhouri TH , Carroll MD , Hales CM , Fryar CD , Li X , Freedman DS . MMWR Morb Mortal Wkly Rep 2017 66 (50) 1369-1373 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. |
BMI trajectories in youth and adulthood
Ogden CL , Freedman DS , Hales CM . Pediatrics 2017 141 (1) Data from numerous longitudinal studies, including the Fels Longitudinal Study and the Bogalusa Heart Study, reveal that youth with higher BMI are more likely to have obesity in adulthood than youth with lower BMI.1 These studies have also revealed that although the positive predictive value of obesity in childhood and adolescence is high (typically >90%), most adults with obesity did not have obesity in childhood or adolescence. In this issue of Pediatrics, Buscot et al2 use an innovative statistical method, the Bayesian Hierarchical Piecewise regression,3 and data from the Young Finns Study between 1980 and 2011 to model BMI trajectories. Similar to other studies, the authors found that individuals with lower BMIs in young childhood, specifically age 6 years, were less likely to have obesity in adulthood. Perhaps more importantly, BMI trajectories in adolescence and early adulthood were important determinants of obesity status between the ages of 34 and 49 years. The unique contribution of the Buscot study is that the rate of BMI change in both childhood and early adulthood and the estimated age at which BMI begins to plateau (or the increases in BMI begin to slow) were associated with the final, adult BMI. Girls with normal weight who became adults with in both childhood and early adulthood, as well as an older mean age (30 vs 17 years) at which the rate of BMI change slowed in comparison with girls with normal weight who were not obese in adulthood. |
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