National Examination Survey Research Articles

The roles of lipids and inflammation in the association between the triglyceride-glucose index and arterial stiffness: evidence from two large population-based surveys

BackgroundThe triglyceride-glucose (TyG) index is a risk marker for arterial stiffness; however, the extent to which the TyG index is associated with arterial stiffness via lipids and inflammation remains unknown. The first aim was to probe the relationship between the TyG index and arterial stiffness in two surveys. The second aim was to clarify whether lipids and inflammation mediate this relationship.MethodsThe sample size of 13,726 U.S. individuals from the National Examination Survey (NHANES) and 3,964 Chinese individuals from the China Health and Retirement Longitudinal Study (CHARLS 2015) were enrolled. Weighted multivariate logistic and linear regression models, as well as restricted cubic spline (RCS) and mediation analyses, were utilized to estimate complex relationships between the TyG index, arterial stiffness, lipids (non-high-density lipoprotein cholesterol [non-HDL-C]) and inflammation (C-reactive protein [CRP]) biomarkers.ResultsA total of 3,420 U.S. patients and 992 Chinese patients were diagnosed with increased arterial stiffness. Regression analyses demonstrated that higher quartiles of the TyG index were associated with a greater incidence of increased arterial stiffness (NHANES: OR = 2.610, 95% CI = 2.043–3.334, P < 0.001; CHARLS: OR = 1.579, 95% CI = 1.057–2.360, P < 0.001). Participants with a higher TyG index/higher CRP level or with a higher TyG index/higher non-HDL-C level had the highest incidence of increased arterial stiffness in the two surveys. The results were still consistent when the sensitivity analysis was implemented with stricter clinical cut-off values of non-HDL-C. Mediation analysis verified that lipids (mediated effect: β = 0.012, P < 0.001 in NHANES; β = 0.020, P < 0.001 in CHARLS) and inflammation (mediated effect: β = 0.003, P < 0.001 in NHANES; β = 0.006, P < 0.001 in CHARLS) partially mediated this relationship.ConclusionsThese results indicated a positive linear correlation between the TyG index, non-HDL-C level, CRP level and increased arterial stiffness in two surveys. Furthermore, lipids and inflammation could partly mediate the correlation of the TyG index with arterial stiffness in both surveys.

Step-by-step towards regular health examination surveys in Portugal

Abstract The 1st National Health Examination Survey was performed in Portugal in 2015 following the EHES procedures. It consisted of a cross-sectional population-based study representative at regional and national level. Individuals aged 25-74 years, residing in Portugal were selected from the national health users’ registry through multi-stage stratified probabilistic sampling. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. A biobank was created which includes serum, plasma, DNA and whole blood of consenting INSEF participants. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research. The data has provided several indicators for the National Health Programs such as tobacco consumption, prevalence of diabetes, obesity, hypertension and dyslipidaemia for the National Program for Tobacco Prevention and control, National Program of Diabetes and National Program for the Promotion of Healthy Eating. In addition, indicators such as excessive salt consumption were used as a starting point for healthy eating campaigns towards reducing its use. The second National Examination Survey is currently being planned and is expected to be held in 2025 in a consortium with the National Food and Nutrition Survey and with the National Serological Survey. The planning and implementation of a single health survey that associates self-reported information on health status and disease, behavioural health determinants, including a detailed dietary and physical activity component, physical examination, and collection of biological products (blood and urine) would constitute an essential source of knowledge for the monitoring, evaluation of public health interventions, and for population-based epidemiological research.

Dynamics of dental morbidity in Armenian adults: A national examination survey during 2003-2018

BACKGROUND AND AIM: Many researchers have stated that the quality of dental care, its accessibility, and insufficient provision of the preventive measures are worsening. The present study was conducted to analyze the epidemiological situation of the dental morbidity in the adult population of Armenia in order to improve the therapeutic and preventive measures. METHODS: Analyses of 1493 World Health Organization (WHO) maps in the key adult age groups evaluated the intensity severity and prevalence of dental caries (682 in Yerevan, Armenia, and 811 in the regions). The condition of periodontal tissues was determined by the Community Periodontal Index (CPI). The state of oral hygiene was assessed by the Simplified Oral Hygiene Index (OHI-S). The data were analyzed in the Statistica software for Excel (version 6.0), using Kruskal-Wallis test, Pearson's chi-square test, and t-test. Statistical significant level was considered at P < 0.05. RESULTS: The prevalence of caries among the adults and older people was within 100% both in Yerevan and its regions. The indicator of the decayed, missing, and filled (DMFT) at the age of 35-44 years in Yerevan was 11.90 and in its regions was 11.02, while the component of missing teeth in Yerevan and its regions was 45.9% and 55.1%, respectively. The average severity index at the age of 65 years and older increased to 27.7. In adulthood, the signs of destructive processes in the periodontium were expressed, and the periodontal pockets of different depths were observed. In the elderly, the prevalence and severity of destructive changes progressed, and there were no significant differences compared in the baseline data. CONCLUSION: According to the results of the present study, older people are at a relatively higher risk of developing oral diseases; therefore, this population group should be involved in preventive measures with an age consideration.

DOES INTERNET USAGE FREQUENCY GIVE IMPACT TO STUDENT’S ACADEMIC PERFORMANCE?

In the last decade, the development of technology has been growing rapidly. Internet—as a part of technology—became one of the very important things for many people. The usage of internet had been increasing in the last few years. It happened to people with various backgrounds and ages around the world. There is an interesting phenomenon that nowadays internet usage behavior is not only happened to adult but also happened to student at school. Some studies have found that internet usage had negative effect on student’s academic performance. But another study emphasized that positive internet usage behavior gave significant effect on academic outcome. In this study, we distinguish internet usage behavior into two categories, viz. general internet user and professional internet user. General internet user refers to internet usage behavior that focus on communication and entertaining purposes. Otherwise, professional internet user refers to productive activities in using internet like searching for information and doing some works that are relevant to assist finishing academic’s tasks. This study aims to find the influence of internet usage—general and professional—on student’s academic performance in Indonesia. Internet usage behavior measured by 2019 Student’s National Examination Survey from Center for Educational Assessment Indonesia. While, student’s academic performance represented by 2019 Indonesian National Examination Score. In addition, studies found that student’s socio-economic status (SES) had influence on their pattern of internet use. Then, this study determined SES as control variable in order to find comprehensive explanation about impact of internet usage on student’s academic outcome.

Factors Affecting Health-related Quality of Life for Subjects with Breast Cancer

Background/Objectives: The purpose of this study was to compare the health-related quality of life between subjects in good health and subjects with breast cancer.Method/Statistical Analysis: A secondary analysis was performed with data from 255 adults using raw data from the Korean National Examination Survey (KNHANES) conducted from 2010 to 2017.Findings: Subjects with breast cancer displayed a poor level of health awareness and high activity confinement. The EQ-5D index scores between subjects in good health and subjects with breast cancer did not show any significant differences. However, factors affecting health related quality of life for subjects with breast cancer and subjects in good health were different. Household income, perceived health status and activity confinement were the strongest factors affecting the health related quality of life among subjects with breast cancer while residential area, level of education, household composition, perceived health status, activity confinement and BMI were significant for subjects in good health.Improvements/Applications: The results of the study will be instrumental in giving insights on health-related quality of life for patients with breast cancer and establishing nursing strategies to promote their HR-QoL.

Dental caries is associated with severe periodontitis in Chilean adults: a cross-sectional study

BackgroundThe co-occurrence of caries and periodontitis and a possible association is still a matter of debate. Thus, the aim of the study was to determine the co-occurrence of caries and periodontitis in Chilean adults.MethodsEvaluation of periodontal and dental status in 994 adults (35–44 years old) based on the First Chilean National Examination Survey 2007–2008. The prevalence of caries was defined as the percentage of participants with one or more teeth with untreated caries by using the D component of the DMFT index (DT ≠ 0). The prevalence of periodontitis was determined using standard case definitions for population-based surveillance of periodontitis described by the CDC–AAP.ResultsIndividuals with caries had an approximately 40% higher prevalence of severe (29.3% vs 20.8%, p < 0.05) and a 13% higher prevalence of total periodontitis (89.3% vs 78.4%, p < 0.05) than those without caries. Ordinal logistic regression revealed a positive association between periodontitis and the number of teeth with caries (DT ≠ 0; 3 or 4 teeth with caries: OR 1.74; CI = 1.12–2.29 p < 0.05; 5 or more teeth with caries: OR 2.47; CI = 1.66–3.67 p < 0.01).ConclusionDental caries is associated with the severity and prevalence of periodontitis in Chilean adults. Individuals with 3 or more teeth with untreated caries are more likely to suffer from periodontal disease.

Validation of Previous Spirometric Reference Equations and New Equations.

BackgroundPulmonary functions are interpreted using predicted values from reference equations that vary with ethnicity, gender, age, height, and weight. The universally used Choi's reference equations are not validated for Korean populations, and the purpose of this study was to validate them and develop new reference equations.MethodsSubjects with normal spirometry and chest radiographs, no co-morbidities, and non-smokers, from the Korean National Health and National Examination Survey (KNHANES)-VI were enrolled (n = 117). Intraclass correlation coefficient (ICC) was assessed for reliability of reference equations. New reference equations were developed using linear regression analysis. Differences between observed and predicted values were assessed to compare the reference equations from Choi's, Global Lung Function Initiative 2012, KNHANES-IV, and newly developed equations.ResultsThe ICC of Choi's reference equations was 0.854 (P < 0.001). The new reference equations for men were: forced vital capacity (FVC) (L) = − 4.38775 − 0.01184 × age + 0.05547 × height, forced expiratory volume – 1 second (FEV1) (L) = − 2.40147 − 0.02134 × age + 0.04103 × height; and for women: FVC (L) = − 3.09063 + 0.003904 × age + 0.038694 × height; FEV1 (L) = − 1.32933 − 0.00872 × age + 0.02762 × height. The differences between the predicted and observed means were largest in Choi's equations, but lowest in the new equations with highest goodness of fit.ConclusionBecause Choi's reference equations presented larger differences from the observed values, despite reliability, and the new reference equations showed better goodness of fit, we suggest the latter for Korean populations.

Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990–2011

Objective: Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. Methods: Data were drawn from three national examination surveys conducted in 1990–1992, 1997–1999 and 2008–2011 (n = 18,541; age range: 25–69 years). Obesity was defined by a body mass index ≥30 kg/m² using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. Results: In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01–1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05–0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19–1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI –0.27 to 0.92, p = 0.283). Conclusions: These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.

Change in Diabetes Prevalence and Control among New York City Adults: NYC Health and Nutrition Examination Surveys 2004-2014.

National examination surveys provide trend information on diabetes prevalence, diagnoses, and control. Few localities have access to such information. Using a similar design as the National Health and Nutrition Examination Survey (NHANES), two NYC Health and Nutrition Examination Surveys (NYC HANES) were conducted over a decade, recruiting adults ≥ 20years using household probability samples (n= 1808 in 2004; n= 1246 in 2013-2014) and physical exam survey methods benchmarked against NHANES. Participants had diagnosed diabetes if told by a health provider they had diabetes, and undiagnosed diabetes if they had no diagnosis but a fasting plasma glucose ≥ 126mg/dl or A1C ≥ 6.5%. We found that between 2004 and 2014, total diabetes prevalence (diagnosed and undiagnosed) in NYC increased from 13.4 to 16.0% (P= 0.089). In 2013-2014, racial/ethnic disparities in diabetes burden had widened; diabetes was highest among Asians (24.6%), and prevalence was significantly lower among non-Hispanic white adults (7.7%) compared to that among other racial/ethnic groups (P< 0.001). Among adults with diabetes, the proportion of cases diagnosed increased from 68.3 to 77.3% (P= 0.234), and diagnosed cases with very poor control (A1C > 9%), decreased from 26.9 to 18.0% (P= 0.269), though both were non-significant. While local racial/ethnic disparities in diabetes prevalence persist, findings suggest modest improvements in diabetes diagnosis and management.

The incidence of hypertension and its risk factors in the German adult population: results from the German National Health Interview and Examination Survey 1998 and the German Health Interview and Examination Survey for Adults 2008-2011.

To analyze incident hypertension and its risk factors based on 11.9 years follow-up of a recent National Examination Survey cohort in Germany. Out of 7124 participants of the German National Health Interview and Examination Survey 1998 (GNHIES98), 640 had died at follow-up 2008-2011 and 3045 were reexamined as part of the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Baseline and follow-up included standardized blood pressure (BP) measurements. Hypertension was defined as BP of at least 140/90 mmHg or intake of antihypertensive medication in participants with known hypertension. Out of 2231 GNHIES98-DEGS1 participants aged 18-79 years without hypertension in 1998, 26.2% developed hypertension within a mean of 11.9 (range 10.0-14.1) years (men 29.0%, women 23.4%). In univariate analysis, hypertension incidence was positively associated with age, BMI, initial BP levels, pulse pressure, and alcohol consumption. Comorbidities such as diabetes and hyperlipidemia increased the chance to develop hypertension. In the multivariate model, initial SBP and DBP levels had the strongest influence on the development of future hypertension (7% increase in men and 5% in women per mmHg SBP). The percentage of aware, treated, and controlled hypertensive patients were 75.8, 62.1, and 50.3% in men and 83.8, 73.3, and 59.0% in women. The high 11.9-year incidence in all age groups points to the lifelong potential for prevention of hypertension.

65세 이상 한국 노인들의 결손치와 흡연의 융합관계

본 연구는 제 4기 (2007-2009년도) 국민건강영양조사를 활용하여 65세 이상 1,565명 노인을 대상으로 결손치아에 미치는 요인과 결손치아와 흡연과의 연관성을 알아보고자 하였다. 인구사회학적 특성은 연령에서 나이가 들면서 결손치가 증가하였고, 특히 흡연과 결손치아의 연관성을 알아보기 위하여 사회경제적인 요인 및 행태들을 보정한 후 흡연상태와 성별, 사회경제적인지위, 치과방문패턴과 연관성을 알아본 결과, 남자보다 여자가 현재흡연상태에서 결손치아수가 높게 나타났으며, 사회경제적지위인 '하'에서 결손치아수가 높게 나타났다(p<0.000). 치과 방문패턴에서는 1년에 치과를 2번 이상 방문에서 결손치아수가 높게 나타나 향후 추가적인 연구를 통해 치과차원의 예방적인 금연정책이 필요할 것으로 보인다. This study aims to investigate the factors affecting tooth loss and the association between smoking and tooth loss, by using the forth Korea National Health and National Examination Survey(2007-2009) of 1,565 elderly people over 65 years old. In terms of the characteristics, as age increases, tooth loss increases. In particular, according to the results of the analysis that identify the correlation between smoking to gender, socio-economic status and dental visiting patterns after correcting socio-economic factors and behavior, it is clear that male's tooth loss is higher than female's in current smoking and tooth loss is caused highly in the lower socio-economic status. In the dental visiting patterns, tooth loss is high when visiting more than twice a year. Therefore, it seems to need a preventive non-smoking policy at the level of dental services through further studies.

Übergewicht und Adipositas in Deutschland

The increase in overweight and obesity is a worldwide health problem. The first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1), conducted from 2008 through 2011, provides current data about overweight and obesity among adults in Germany. Within DEGS1, a representative sample of the 18- to 79-year-old population was interviewed with regard to health relevant issues and physically examined (n = 7,116). From measurements of body height and weight, the body mass index (BMI) was calculated, which was used to define overweight (BMI ≥ 25 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)). Results are stratified for gender, age group, socioeconomic status and region and compared with results from the German National Health Interview and Examination Survey 1998 (GNHIES98) and the National Examination Surveys 1990/92. According to DEGS1, 67.1% of men and 53.0% of women are overweight. The prevalence of overweight has not changed compared to GNHIES98. The prevalence of obesity, however, has risen substantially, especially among men: in GNHIES98, 18.9% of men and 22.5% of women were obese, in DEGS1, these figures were 23.3% and 23.9%, respectively. The increase in obesity occurred especially among young adults. An English full-text version of this article is available at SpringerLink as supplemental.

The prevalence, correlates and impact of anaemia among older people in Cuba, Dominican Republic, Mexico, Puerto Rico and Venezuela

Anaemia among older people is increasingly recognized as a matter of public health concern. Data from low- and middle-income countries are sparse. We surveyed 10915 people aged 65years and over (8423 with blood tests) in catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela and Mexico, to assess prevalence and correlates of anaemia and impact on disability. Prevalence varied widely between sites, from 6·4% in rural Mexico to 9·2% in urban Mexico, 9·8% in Venezuela, 19·2% in Cuba, 32·1% in Puerto Rico and 37·3% in Dominican Republic. Prevalence was higher in men and increased with age, but sociodemographic composition did not account for prevalence differences between sites. Standardized morbidity ratios indicated a much higher prevalence in Cuba (173), Puerto Rico (280) and Dominican Republic (332) compared with USA National Health and National Examination Surveys. Anaemia was associated with undernutrition, physical impairments, and serum creatinine. There was an association with greater African admixture in Dominican Republic but not in Cuba. African admixture is therefore unlikely to fully explain the high prevalence in the Caribbean islands, which may also arise from environmental, possibly dietary factors. Given an important independent contribution of anaemia to disability, more research is needed to identify preventable and treatable causes.

Adolescent lipoprotein classifications according to National Health and Nutrition Examination Survey (NHANES) vs. National Cholesterol Education Program (NCEP) for predicting abnormal lipid levels in adulthood in a Middle East population

BackgroundTo compare the predictive ability of adolescent lipoprotein classification using the National Examination Survey (NHANES) cut points and those of the National Cholesterol Education Program (NCEP) for predicting abnormal levels in adulthood.MethodFrom 1032 adolescents, aged 14–19 years, participants of the Tehran Lipid and Glucose Study, all lipid measures were determined at baseline and again after 6 years. Multivariable Odds Ratios (ORs) were calculated for borderline and high categories of lipids to predict dyslipidemia in adulthood, considering the normal level as a reference. Area under the receiving characteristics curve (AUC) was used to assess the predictive ability of each adolescent lipid classification.ResultApplying the NCEP classification, the prevalences of high total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides and low high density lipoprotein cholesterol (HDL-C) in males were 12.1%, 12.9%, 26.1% and 34.2% respectively; in females the corresponding prevalences were 15.4%, 17.9%, 21.4% and 25.0%, respectively. Using NHANES cut points, the prevalence of high TC, LDL-C and triglycerides were lower, than those defined by NCEP; the ORs of high categories of lipids (defined by NHANES) were higher than ORs based on the NECP classification, except for HDL-C. For all lipid measures, both classifications had similar predictive abilities, except for TC/HDL-C, which had higher predictive power applying the NHANES classification rather than the NCEP one (AUC 71% vs. 68%, respectively).ConclusionNo differences were found between NCEP and NHANES classifications for prediction of adult dyslipidemia, except for TC/HDL-C. Because of their simple application, NCEP cut points can be used in clinical settings.

Overview and quality assurance for the National Health and Nutrition Examination Survey (NHANES) oral health component, 1999–2002

The Oral Health Component of the 1999-2002 National Health and Nutrition Examination Survey (NHANES) is a collaborative effort between the National Institute of Dental and Craniofacial Research (NIDCR), the National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health (NCCDPHP/DOH), and the National Center for Health Statistics (NCHS). The current NHANES is designed as a continuous survey with data released on a 2-year cycle to represent the civilian, non-institutionalized population of the US. Oral health data are currently available for 8082 and 9010 persons aged > or =2 years who participated in the 1999-2000 and 2001-2002 NHANES, respectively. This article provides background information on previous national examination surveys with oral health content. It also provides general analytical considerations, oral health content information, and evaluations of data quality in terms of examiner reliability statistics (percent agreements, kappa, and correlation coefficients) for the 1999-2002 NHANES Oral Health Component.

Übergewicht und Adipositas in Deutschland 1984–2003

The magnitude and the development of the prevalence of overweight and obesity in Germany during the past 20 years are analysed in this contribution. Using body mass index (BMI) data of the National Examination Surveys (1984-1992), the German National Health Interview and Examination Survey 1998 as well as the Telephone Health Survey 2003, all representative of the adult non-institutionalised population, the occurrence of overweight and obesity is studied. To improve the comparability with measurement values, the Telephone Health Survey data which were based on self-reporting were adjusted. All data were weighted to improve the representativeness for the time of assessment. Although the proportion of persons with a BMI between 25 and 30 did not change essentially during the last 20 years, the proportion of obese individuals (BMI>or=30) increased considerably. At present, about 70% of men and 50% of women in Germany are overweight or obese. In conclusion, the prevalence of overweight and obesity in Germany continues to increase.

Gravidity and Serum Lipids among Hispanic Women in the Hispanic Health and Nutrition Examination Survey

ABSTRACT Objective: Previous studies regarding the relationship between reproductive history and lipids have consistently shown an association between gravidity or parity and high-density lipoprotein (HDL)-cholesterol. However, no previous study has had sufficient power to assess the association between reproductive history and lipids among women of high gravidity. The current study evaluates reproductive history and lipids in a representative sample of Hispanic women for whom multigravidity and multiparity are common. Design: National examination survey designed to estimate the health and nutritional status of noninstitutionalized civilians. Participants: 1590 Mexican-American, 411 Cuban-American, and 657 Puerto Rican women ages 20–74. Main Outcome Measures: HDL-cholesterol, total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglycerides. Results: Adjusted for age, body mass index (BMI), diabetes, menopausal status, alcohol use, and smoking status, HDL-cholesterol was 3.9 mg/dL lower in M...