National Health And Examination Survey Research Articles

The different association between fat mass distribution and intake of three major nutrients in pre- and postmenopausal women.

Obesity, characterized by excessive body fat accumulation, is associated with various chronic health conditions. Body fat plays a crucial role in health outcomes, and nutrient intake is a contributing factor. Menopause further influences body fat, but the precise relationships between nutrients and fat mass distribution in pre- and post-menopausal women are unclear. Data from 4751 adult women aged ≥18 years old (3855 pre-menopausal, 896 post-menopausal) with completed information were obtained from the National Health and Examination Survey (NHANES) from 2011 to 2018. Multivariate linear regression models were used to examine the associations between protein, carbohydrate, fat intake and total percent fat (TPF), android percent fat (APF), gynoid percent fat (GPF), android to gynoid ratio (A/G), subcutaneous adipose tissue mass (SAT), visceral adipose tissue mass (VAT). Subgroup analyses, stratified by menopausal status, were also conducted. Additionally, we employed smoothing curve fitting techniques to investigate potential non-linear relationships between fat mass distribution and nutrient intake. Compared with pre-menopausal women, post-menopausal women had higher body fat, BMI, and metabolic indicators but lower nutrient intake (All p<0.05). In the overall analysis, we found significant correlations between nutrient intake and fat mass. Specifically, protein intake was negatively correlated with TPF (β = -0.017, 95% CI: -0.030, -0.005), APF (β = -0.028, 95% CI: -0.044, -0.012), GPF (β = -0.019, 95% CI: -0.030, -0.008), while fat intake showed positive correlations with these measures (SAT: β = 2.769, 95% CI: 0.860, 4.678). Carbohydrate intake exhibited mixed associations. Notably, body fat mass-nutrient intake correlations differed by menopausal status. Generally speaking, protein intake showed negative correlations with body fat distribution in pre-menopausal women but positive correlations in post-menopausal women. Carbohydrate intake revealed significant negative associations with abdominal and visceral fat in post-menopausal women, while fat intake was consistently positive across all fat distribution indices, especially impacting visceral fat in post-menopausal women. Dietary intake plays a crucial role in body fat distribution, with menopausal status significantly influencing the impact of nutrients on specific fat distribution metrics. The study emphasizes the need for dietary guidelines to consider the nutritional needs and health challenges unique to women at different life stages, particularly concerning menopausal status, to effectively manage obesity.

Interaction between visual impairment and subjective cognitive complaints on physical activity impairment in U.S. older adults: NHANES 2005–2008

Background/aimTo investigate the independent relationships of visual impairment (VI) and Subjective cognitive complaints (SCC) with physical function impairment (PFI) and the interaction effect between VI and SCC on PFI in American older adults.MethodsThe data of this cross-sectional study was obtained from the 2005–2008 National Health and Examination Survey (NHANES) conducted in the United States. The VI criterion included both subjective self-reported eyesight conditions and objective visual acuity test results. The self-reported questionnaires were utilized to determine PFI and SCC. According to the survey design of NHANS, original data were weighted to produce nationally representative estimates. Both the unweighted original data and weighted estimates underwent analysis. Crude and adjusted logistic models were employed to assess the pairwise associations among VI, SCC, and PFI. To assess the interactive effect, measures such as the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S) were calculated.ResultsA total of 2,710 subjects (weighted n = 38,966,687) aged 60 years or older were included. Compared with subjects without subjective visual impairment (SVI), those with SVI had a significant positive association with PFI [weighted OR (95%CI): 3.11 (2.25, 4.31)]. After multi-variable adjusting, the relationship remained significant [weighted OR (95%CI): 1.90 (1.32, 2.72)]. Similarly, those with objective visual impairment (OVI) were positively associated with the risk of PFI in the crude model [weighted OR (95%CI): 2.35 (1.53, 3.61)] and adjusted model [weighted OR (95%CI): 1.84 (1.07, 3.17)]. Moreover, we found the association of SCC with an increased risk of FPI [crude weighted OR (95%CI): 5.02 (3.40, 7.40); adjusted weighted OR (95%CI): 3.29 (2.01, 5.38)]. Ultimately, the additive interaction showed there was a significant positive interaction term between SVI and SCC on PFI, while OVI and SCC did not.ConclusionBoth VI and SCC were significantly associated with PFI in elder adults. Besides, there was a significant synergistic interaction between SVI and SCC on PFI, which indicated the improvement of SVI and SCC may be beneficial for the prevention of PFI. For the elderly, especially those with multiple disabilities, comprehensive and targeted approaches are imperative to foster their overall well-being and health.

IgE to common food allergens is associated with cardiovascular mortality in the National Health and Examination Survey and the Multi-Ethnic Study of Atherosclerosis

In individuals without symptomatic food allergy, food-specific IgE is considered clinically irrelevant. However, recent studies have suggested that galactose-α-1,3-galactose (alpha-gal) IgE is associated with cardiovascular (CV) disease. We sought to determine whether sensitization to common food allergens is associated with CV mortality. The association between IgE sensitization to foods and CV mortality ascertained to 2019 was examined in the National Health and Examination Survey (NHANES) 2005-2006 and the Wake Forest site of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort; MESA enrolled adults without baseline clinical CV diseases between 2000 and 2002. Total and specific IgE was measured to cow's milk, egg, peanut, shrimp, and a panel of aeroallergens (NHANES), and to cow's milk, alpha-gal, peanut, dust mite, and timothy grass (MESA). Cox proportional hazard models were constructed, adjusting for sex, age, race/ethnicity, smoking, education, and asthma. A total of 4414 adults from NHANES (229 CV deaths) and 960 from MESA (56 CV deaths) were included. In NHANES, sensitization to at least 1 food was associated with higher CV mortality (hazard ratio [HR], 1.7 [95% confidence interval (CI), 1.2-2.4], P= .005). Milk sensitization was particularly associated (HR, 2.0 [95% CI, 1.1-3.8], P= .026), a finding replicated in MESA (HR, 3.8 [95% CI, 1.6-9.1], P= .003). Restricting analyses in NHANES to consumers of the relevant allergen strengthened food sensitization relationships, unmasking shrimp and peanut sensitization as additional risk factors for CV mortality. The finding that food sensitization is associated with increased risk of CV mortality challenges the current paradigm that sensitization without overt allergy is benign. Further research is needed to clarify mechanisms of this association.

Exploring health advice by dental professionals in USA: A secondary data analysis of NHANES (2015–2018)

ObjectivesTo examine socioeconomic and ethnic variations in the provision of health advice by dental professionals. MethodsData were from the National Health and Examination Survey (NHANES) (2015–2018). Socioeconomic position (Poverty-income ratio and education) and ethnicity were the main exposures. The outcome variable of interest was whether participants received health advice regarding the "benefits of quitting cigarettes," "benefits of monitoring blood sugar levels," and "importance of oral cancer screening". Logistic regression analysis was used to examine the relationship between socioeconomic factors/ethnicity, and health advice after adjusting for covariates. ResultsThe analysis included a total of 5524 people aged eighteen and above who had complete data. Black and Hispanic individuals had higher odds of receiving advice on smoking (OR = 1.49, 95% CI: 1.04–2.12 and OR = 1.48, 95% CI: 1.05–2.07, respectively) and glucose monitoring (OR = 3.00, 95% CI: 2.03–4.43 and OR = 3.14, 95% CI: 2.04–4.82, respectively), but no significant difference for cancer screening advice.Higher poverty-income ratios (PIR) were associated with lower odds of receiving smoking advice (OR = 0.91, 95% CI: 0.84–0.98), but no significant associations were observed for glucose monitoring or cancer screening advice. The study's findings reveal a social gradient in the provision of cancer advice, with individuals having higher education levels, particularly university education (OR = 1.69, 95% CI: 1.24–2.31), showing significantly higher odds of receiving cancer screening advice ConclusionThe study highlights significant variations in health advice provision in dental settings, with education level, ethnicity, and smoking status playing prominent roles, emphasizing the need for targeted interventions to promote equity and cultural competence in delivering health advice in dental settings. Practice implicationThe results emphasize the importance of strong policies and ongoing education for dental professionals to ensure optimal treatment and prevention.

A Dietary Model of Partial Meat Replacement with Walnuts Demonstrates Changes in the Nutrient Profile and Quality of the United States Population's Diet.

The purpose of the study is to assess the impact of partial meat replacement with walnuts using a dose-escalation approach on nutrient intake and diet quality in the usual US diet. Food modeling was implemented using the nationally representative 2015-2018 National Health and Examination Survey (NHANES), with a focus on non-nut consumers, which included 2707 children and adolescents and 5190 adults. Walnuts replaced meat in a dose-escalating manner (0.5, 1, 1.5, and 2 oz walnuts per day replaced 1, 2, 3, and 4 oz meat, respectively). Diet quality was estimated using the population ratio method of the 2015 Healthy Eating Index. The usual intake of nutrients was estimated using the National Cancer Institute method. Significant differences were determined using non-overlapping 95% confidence intervals. The partial replacement of meat with walnuts demonstrated significant increases in the mean intake of fiber, magnesium, and omega-3 fatty acids and significant decreases in cholesterol and vitamin B12 in the modeled diets for children, adolescents, and adults. Additionally, the partial replacement of meat with walnuts improved overall diet quality. Walnut consumption at 1-2 oz as a replacement for some meat may improve nutrient intake and diet quality across age groups.

Associations between homocysteine and B vitamins and stroke: a cross-sectional study.

Homocysteine (Hcy) is a predictor for stroke. B vitamins are required for the metabolism of Hcy. We designed a study to investigate the associations of plasma Hcy and B vitamins with the prevalence of stroke in adults. A total of 8,371 adults were included in the National Health and Examination Survey (NHANES) between 2003-2006 in the United States. Multivariate regression analysis and smooth curve fitting were conducted to evaluate the associations of stroke prevalence with Hcy, folate, vitamin B6, and B12. A segmented regression model was used to analyze the threshold effects. Sample weights were calculated to ensure the results' generalizability. The mean age of all participants was 46.43 years (51.8% women), and the prevalence of stroke was 2.72%. A nonlinear and positive association was found between plasma Hcy levels and the prevalence of stroke. Furthermore, L-shaped associations were found between plasma vitamin B6 and folate levels and stroke, with the turning point at 65.2 nmol/L for vitamin B6 and 26 nmol/L for folate, respectively. Vitamin B12 revealed a U-shaped relationship with stroke, with the turning points at 492.98 pmol/L for vitamin B12. Non-linear associations of plasma Hcy and B vitamins levels with stroke prevalence were found in American adults. These associations may have an implication that higher plasma Hcy levels should be reduced, and plasma vitamin B6, vitamin B12 and folate levels should be moderately improved in stroke prevention. Future studies are needed to verify the causality of these associations and elucidate the underlying mechanisms.

Phthalate mixtures and insulin resistance: an item response theory approach to quantify exposure burden to phthalate mixtures.

Molar sums are often used to quantify total phthalate exposure, but they do not capture patterns of exposure to multiple phthalates. To introduce an exposure burden score method for quantifying exposure to phthalate metabolites and examine the association between phthalate burden scores and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). We applied item response theory (IRT) to data from 3474 adults aged 20-60 years in the 2013-2018 National Health and Examination Survey (NHANES) to quantify latent phthalate exposure burden from 12 phthalate metabolites. We compared model fits of three IRT models that used different a priori groupings (general phthalate burden; low molecular weight (LMW) and high molecular weight (HMW) burdens; and LMW, HMW and DEHP burden), and used the best fitting model to estimate phthalate exposure burden scores. Regression models assessed the covariate-adjusted association between phthalate burden scores and HOMA-IR. We compared findings to those using molar sums. In secondary analyses, we examined how the IRT model could be used for data harmonization when a subset of participants are missing some phthalate metabolites, and accounted for measurement error of the phthalate burden scores in estimating associations with HOMA-IR through a resampling approach using plausible value imputation. A three correlated factors model (LMW, HMW and DEHPburdens) provided the best fit. One interquartile range (IQR) increase in DEHP burden score was associated with 0.094 (95% CI: 0.022, 0.164, p = 0.010) increase in log HOMA-IR, co-adjusted for LMW and HMW burden scores. Findings were consistent when using log molar sums. Associations of phthalate burden and insulin resistance were also consistent when participants were simulated to be missing some phthalate metabolites, and when we accounted for measurementerror in estimating burden scores. Both phthalate molar sums and burden scores are sensitive to associations with insulin resistance. Phthalate burden scores may be useful for data harmonization.

P-740 Social disparities in pregnancy awareness among individuals in the general U.S. population

Abstract Study question What are socio-demographic and lifestyle characteristics of pregnant individuals who were aware versus those who were unaware of pregnancy status in the general U.S. population. Summary answer Women unaware of their pregnancy status were more likely to be Non-Hispanic Black, living below the poverty line, and unmarried. What is known already The early weeks of pregnancy are critical for fetal programming of organ systems and consequently long-term offspring health. Individuals who are unaware of pregnancy are at risk of poor nutrition, inadvertent environmental chemical exposures and risky behaviors/lifestyles that contribute to inadequate prenatal care. Lack of pregnancy awareness increases the risk of pregnancy complications and misses opportunities for early intervention. Study design, size, duration We included 842 individuals aged between 20 to 44 years who had a positive urine pregnancy test result at time of the cross-sectional National Health and Examination Survey (NHANES), 2003-2016 cycles. Participants/materials, setting, methods The urine pregnancy tests and reproductive health interviews were conducted concurrently in medical examination center. We defined participants with a positive urine pregnancy test result but who reported not being pregnant during the interview as being unaware of their pregnancy status. Information on demographic, socio-economic, and lifestyle characteristics were collected by questionnaires. We employed student t test and chi-square test to compare the characteristics between individuals who were aware vs. unaware of the pregnancy. Main results and the role of chance Among 842 pregnant individuals, 62 (7.36%) were unaware of their pregnancy status. The mean (SE) ages (years) were similar between individuals who were unaware vs. those aware of their pregnancy status (Unaware: 28.05 (0.96) vs. Aware: 28.48 (0.32)). Compared with aware individuals, a higher proportion of the unaware group were Non-Hispanic Black (Unaware: 36.31% vs. Aware: 13.06%; p &amp;lt; 0.001), living in poverty (Unaware: 30.03% vs. Aware: 18.95%; p = 0.09), and unmarried (Unaware: 68.12% vs. Aware: 30.45%; p &amp;lt; 0.001). No significant differences were found for education (College degree and above: Unaware: 60.73% vs. Aware: 67.73%; p = 0.33) and smoking behavior between the two groups (Current smoker: Unaware: 4.97% vs. Aware: 8.88%; p = 0.38). Limitations, reasons for caution The sample size of this study was relatively small. Findings may not be representative of population characteristics. Wider implications of the findings Our findings point to significant social disparities in pregnancy awareness and have important implications for clinical practice and early identification of high-risk pregnancies. Trial registration number not applicable

Associations of walking impairment with visual impairment, depression, and cognitive function in U.S. older adults: NHANES 2013–2014

BackgroundWalking impairment, a common health problem among older adults, has been linked to poor vision and mental health. This study aimed to investigate the associations of walking impairment with visual impairment, depression, and cognitive function in older adults.MethodsA total of 1,489 adults aged 60 years and older who had participated in the National Health and Examination Survey (NHANES) 2013–2014 in the United States were included. Multivariate logistic regression models were used to examine the associations of walking impairment with visual impairment, depression, and four subdomains of cognitive function. Sample weights were used to ensure the generalizability of the results.ResultsAmong all the participants (median age = 68 years; 53.7% women), 17.5% reported walking impairment. Walking impairment was significantly associated with visual impairment (adjusted odds ratio [aOR] = 2.76; 95% CI: 1.47–5.20) and depression (aOR = 4.66; 95% CI: 3.11–6.99). Walking impairment was only associated with the Digit Symbol Substitution (DSST) subdomain of cognitive function in total participants (aOR = 0.97; 95% CI: 0.95–0.99) and in non-Hispanic white adults (aOR = 0.96; 95% CI: 0.94–0.98). Participants with two or three impairment indicators had a higher OR of walking impairment (aOR = 3.64, 95% CI = 2.46–5.38) than those with 0–1 (reference group) impairment indicator.ConclusionsWalking impairment was associated with visual impairment, depression, and cognitive impairment in American older adults and also positively associated with the number of impairment indicators. The association between walking impairment and cognitive impairment varied according to race. Evaluations of vision, cognition, and depression should be conducted among older adults with walking impairment, and the needs of older adults should be provided in the evaluations alongside information on the biological aspects of their particular race.

Impact of Replacing Meat With Walnuts: Results of an NHANES Modeling Study

ObjectivesTo assess the impact of replacing meat with walnuts in a dose escalation manner in the usual US dietary intake pattern. MethodsFood modeling was implemented in the nationally representative 2015–2018 National Health and Examination Survey (NHANES) in a population of 5,807 adults, 19 years and older of no-nut consumers. Walnuts replaced meat in a dose escalating manner (i.e., 0.5, 1, 1.5, and 2 oz equivalents per day) in the usual dietary intake in this modeling study. Diet quality was estimated using the population ratio method of the Healthy Eating Index (HEI-2015). The usual intake of nutrients was estimated using the National Cancer Institute (NCI) method. Significant differences were determined using non-overlapping 95% CIs. ResultsReplacing meat at any dose level with walnuts significantly improved the mean intake of fiber, magnesium, omega 3 while reducing the cholesterol intake. Further, vitamin B12 intake was significantly reduced while no significant decline in iron intake was observed. Diet quality in the modeled diets (after replacing meat with walnuts) was significantly higher compared to diet quality in the usual diet. Better diet quality scores were mainly driven by strong improvements in the HEI components “Seafood and Plant Protein” and “Fatty Acid Ratio.” ConclusionsThe partial replacement of meat with walnuts improved overall diet quality and increased the intake of magnesium, fiber, and omega 3 but adversely affected vitamin B12. Funding SourcesThis study was funded by the California Walnut Commission.

Adding Walnuts to the Diet of Children and Adolescents Improved the Diet Quality: Results of an NHANES Modeling Study

ObjectivesTo assess the impact of adding one ounce of walnuts on nutrients of public health concern and diet quality. MethodsFood modeling was implemented in the nationally representative 2015–2018 National Health and Examination Survey (NHANES) in a population of 4,756 children and adolescents of no-nut consumers. One ounce of walnuts was added to the usual dietary intake in this modeling study. The Healthy Eating Index-2015 was used as a summary measure of diet quality. Outcomes of interest were intakes of fiber, protein, potassium, folate, magnesium, and omega 3. Nutrient intake was analyzed using the National Cancer Institute method (NCI), while the HEI-2015 score was estimated using the population ratio method. Significant differences were determined using non-overlapping 95% CIs. ResultsHEI-2015 scores were significantly higher in Modeled diet compared to usual diets (58.5 ± 0.5 vs. 49.1 ± 0.6) out of 100 total points. Adding walnuts increased the energy density per 1,000 calories of the total protein, seafood and plant proteins, and polyunsaturated fatty acids, thus increasing the individual component HEI scores in these areas. Compared to usual diet, modeled diet significantly improved inadequacy for magnesium (48.3% to 34.6%), folate (28.3 to 22.0%), Copper (16.2%to 0.2%), and zinc (21.1% to 14.7%). Further, mean fiber intake significantly increased from 13.6 ± 0.2 to 15.4 ± 0.2 grams. ConclusionsPublic health messages targeted at no-nut consumers should emphasize the benefits of nut consumption, specifically walnuts, to improve diet quality. Further, adding walnuts to the diet improves the inadequacy of folate, magnesium, and trace minerals. Food pattern modeling using NHANES data can be used to assess nutritional impacts of compliance to current dietary guidance. Funding SourcesThis study was funded by the California Walnut Commission.

The Correlation of Total Percent Fat With Alterations in Cholesterol and Triglycerides in Adults

BackgroundTo evaluate the detailed relationship between total percent fat (TPF) and cardiovascular disease (CVD)-related lipid biomarkers among adults and find a non-invasive indicator for screening and monitoring of the high CVD risk population.MethodsData of 13,160 adults were obtained from the National Health and Examination Survey (NHANES) from 1999 to 2018. TPF was assessed by dual-energy x-ray absorptiometry (DXA), and CVD-related lipid biomarkers included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Multivariable linear regression models were used to examine associations between TPF with four kinds of lipid biomarkers, and smooth curve fittings and generalized additive models were used to address the non-linear relationship between them. The inflection points were calculated by the recursive algorithm when non-linearities were detected and then weighted two-piecewise linear regression models were constructed.ResultsIn multivariable regression, increasing TPF was positively associated with TC, TG, and LDL-C and negatively with HDL-C (all p < 0.001). In addition, the non-linear relationships between them were also identified by generalized additive models and smooth curve fittings. When further stratified TPF by sex, the fitted smooth curves were nearly inverted U-shaped and U-shaped curves, the inflection points were calculated, and the weighted two-piecewise linear regression models were constructed, respectively. The same results existed between android percent fat and these four lipid biomarkers.ConclusionsTotal percent fat was significantly associated with CVD-related lipid biomarkers in adults, positively with TC, TG, and LDL-C and negatively with HDL-C. It could be used as a non-invasive screener and monitor of high CVD risk population when their TPF values were less than the inflection points.

Examining the Relationship between Toxoplasma gondii and Seropositivity and Serointensity and Depression in Adults from the United Kingdom and the United States: A Cross-Sectional Study.

Infecting approximately one-third of the world’s population, the neurotropic protozoan Toxoplasma gondii has been associated with cognition and several neuropsychiatric diseases including schizophrenia and bipolar disorder. Findings have been mixed, however, about the relationship between Toxoplasma gondii and depression, with some studies reporting positive associations and others finding no associations. To further investigate the association between Toxoplasma gondii and depression, we used data from the UK Biobank and the National Health and Examination Survey (NHANES). Results from adjusted multiple-regression modeling showed no significant associations between Toxoplasma gondii and depression in either the UK Biobank or NHANES datasets. Further, we found no significant interactions between Toxoplasma gondii and age, sex, educational attainment, and income in either dataset that affected the association between Toxoplasma gondii and depression. These results from two community-based datasets suggest that in these samples, Toxoplasma gondii is not associated with depression. Differences between our findings and other findings showing an association between Toxoplasma gondii and depression could be due to several factors including differences in socioeconomic variables, differences in Toxoplasma gondii strain, and use of different covariates in statistical modeling.

Choline Intake Was Mildly Associated With Hypertension Among Older Adults in Cross-Sectional NHANES 2011–2014

ObjectivesThe study objective is to investigate the relationships of choline intake with blood pressure (BP) and hypertension among U.S. adults aged ≥65 y using the sample from the 2011–2014 National Health and Examination Survey (NHANES). The association between choline-containing supplement usage and BP in adults aged ≥20 y was also assessed to confirm previous findings. MethodsThe cross-sectional associations of choline intake with prevalent hypertension (n = 2113) and BP (n = 843) were assessed among the NHANES older adults using logistic and multiple linear regression models for complex surveys, respectively. Logistic regression was used to test the association between supplemental choline use and prevalent hypertension in adults aged ≥20 y (n = 9561). Effect modification by sex, race/ethnicity, body mass index (BMI) and comorbidity were also investigated. ResultsAmong older adults, choline intake interacted with BMI (P-interaction = 0.04) such that choline intake tended to be associated with lower odds of hypertension among people with BMI lower than 18.5 kg/m2 (odds ratio [95% Confidence Interval], OR [95% CI]: 0.64 [0.4,1.00]; P = 0.052). Choline intake was not associated with systolic BP. In contrast, its relation to diastolic BP differed by comorbidity (P-interaction = 0.03) with a negative direction of association observed among those who were free of comorbidities and a positive direction observed among those with comorbidities. No association was found between choline supplement use and the odds of hypertension. ConclusionsCollectively, these results suggested that the associations of choline intake with BP levels and hypertension risk among older adults are mild and dependent on other risk factors. A higher choline intake may be beneficialy associated with BP among people who have healthier profiles. Funding SourcesThis study was supported by the Young Faculty Research Grant, Faculty of Agro-Industry, Chiang Mai, Thailand.

Physical Activity, Sleep, and Sedentary Behavior among Successful Long-Term Weight Loss Maintainers: Findings from a U.S. National Study.

Despite adults’ desire to reduce body mass (weight) for numerous health benefits, few are able to successfully lose at least 5% of their starting weight. There is evidence on the independent associations of physical activity, sedentary behaviors, and sleep with weight loss; however, this study provided insight on the combined effects of these behaviors on long-term body weight loss success. Hence, the purpose of this cross-sectional study was to evaluate the joint relations of sleep, physical activity, and sedentary behaviors with successful long-term weight loss. Data are from the 2005–2006 wave of the National Health and Examination Survey (NHANES). Physical activity and sedentary behavior were measured with an accelerometer, whereas sleep time was self-reported. Physical activity and sleep were dichotomized into meeting guidelines (active/not active, ideal sleep/short sleep), and sedentary time was categorized into prolonged sedentary time (4th quartile) compared to low sedentary time (1st–3rd quartiles). The dichotomized behaviors were combined to form 12 unique behavioral combinations. Two-step multivariable regression models were used to determine the associations between the behavioral combinations with (1) long-term weight loss success (≥5% body mass reduction for ≥12-months) and (2) the amount of body mass reduction among those who were successful. After adjustment for relevant factors, there were no significant associations between any of the independent body weight loss behaviors (physical activity, sedentary time, and sleep) and successful long-term weight loss. However, after combining the behaviors, those who were active (≥150 min MVPA weekly), regardless of their sedentary time, were significantly (p < 0.05) more likely to have long-term weight loss success compared to the inactive and sedentary referent group. These results should be confirmed in longitudinal analyses, including investigation of characteristics of waking (type, domain, and context) and sleep (quality metrics) behaviors for their association with long-term weight loss success.

Validation of a description of sarcopenic obesity defined as excess adiposity and low lean mass relative to adiposity.

BackgroundThis study aims to assess the construct validity of a body composition‐defined definition of sarcopenic obesity based on low appendicular lean mass relative to fat mass (ALMIFMI) and high fat mass index (FMI) and to compare with an alternative definition using appendicular lean mass index (ALMI) and percent body fat (%BF).MethodsThis is a secondary analysis of two cohort studies: the National Health and Examination Survey (NHANES) and the Health, Aging, and Body Composition study (Health ABC). Sarcopenic obesity was defined as low ALMIFMI combined with high FMI and was compared with a widely used definition based on ALMI and %BF cut‐points. Body composition Z‐scores, self‐reported disability, physical functioning, and incident disability were compared across body composition categories using linear and logistic regression and Cox proportional hazards models.ResultsAmong 14, 850 participants from NHANES, patients with sarcopenic obesity defined by low ALMIFMI and high FMI (ALMIFMI‐FMI) had above‐average FMI Z‐scores [mean (standard deviation): 1.00 (0.72)]. In contrast, those with sarcopenic obesity based on low ALMI and high %BF (ALMI‐%BF) had below‐average FMI Z‐scores. A similar pattern was observed for 2846 participants from Health ABC. Participants with sarcopenic obesity based on ALMIFMI‐FMI had a greater number of disabilities, worse physical function, and a greater risk of incident disability compared with those defined based on ALMI‐%BF.ConclusionsBody composition‐defined measures of sarcopenic obesity defined as excess adiposity and lower‐than‐expected ALMI relative to FMI are associated with functional deficits and incident disability and overcome the limitations of using %BF in estimating obesity in this context.

Cardiovascular Risk Scores in Axial Spondyloarthritis Versus the General Population: A Cross-sectional Study.

Cardiovascular (CV) morbidity and mortality are increased in axial spondyloarthritis (axSpA).We conducted a cross-sectional study evaluating the 10-year atherosclerotic cardiovascular disease (ASCVD) risk in axSpA compared to the general US population. We included 211 adults, 40-75 years old with ankylosing spondylitis (AS) or nonradiographic axSpA from 2 sites, who had available data on comorbidities, medication use, blood pressure measures, and laboratory cholesterol values. General population comparators from the 2009-2014 National Health and Examination Survey (NHANES) cycles were matched 4:1 to subjects, on age, sex, and race. We estimated the prevalence ratio for a 10-year ASCVD risk score ≥ 7.5% comparing axSpA and matched NHANES comparators using conditional Poisson regression. Overall, subjects were 53.9 ± 11.2 years old, 69% were male, and 74% were White. The mean 10-year ASCVD risk score was 6.7 ± 6.9% for those with axSpA, and 9.0 ± 10.5% for NHANES comparators. Compared to those with axSpA, the prevalence of current smoking and diabetes was higher among NHANES comparators. The estimated prevalence ratio for a 10-year ASCVD risk score ≥ 7.5% comparing those with axSpA and their age-, sex-, and race-matched comparators was 0.96 (95% CI 0.74-1.24). The prevalence of a 10-year ASCVD risk score ≥ 7.5% was not significantly different comparing axSpA patients and those drawn from the general population who were similar in terms of age, sex, and race. Future studies should focus on improved CV risk prediction in axSpA, because underestimation by a general population risk score may potentially explain these results.

The Association of Caffeine Metabolite with Obesity and Low-Density Lipoprotein Level

Abstract Objectives To examine if waist circumference mediated the relationship between 1, 7-dimethylxanthine (a caffeine metabolite) and serum LDL level, adjusting for age, gender, race/ethnicity, smoking, and alcohol consumption. Methods A secondary data analysis study was conducted using data from the National Health and Examination Survey (NHANES) 2009–2010 data collection wave. The final sample included 1976 weighted respondents. Structural equation modeling was used to examine the objectives of this study. Results Structural equation modeling found that levels of 1, 7-dimethylxanthine were not associated with levels of LDL, and that WC was not a mediator of the relationship, adjusting for the covariates. None of the covariates were associated with LDL level, controlling for WC. Conclusions Further longitudinal studies are needed to more thoroughly examine the role of central obesity on the relationship between caffeine and LDL level. Funding Sources None.

Environmental Impact and Nutrient Quality Assessment of the Current Diet in Surabaya, Indonesia

Abstract Objectives As developing nations’ income continue to rise, individuals have greater access to high caloric foods leading to increases in obesity and associated chronic diseases. Indonesia is one of several countries facing this dietary shift, exhibiting one of the highest prevalence rates of overweight/obesity in Southeast Asia. The current diet, mainly driven by increased meat and fish intake, is also associated with increases in environmental impact. Behavior change is necessary in order to shift diets toward more healthy and sustainable consumption. In this report, we analyzed the environmental impact and nutrition quality of the current diet in Surabaya, Indonesia. Methods We administered a 24-hour dietary recall and supplemental questionnaire assessing preferred diet, food access, diet knowledge, and climate change opinions to 100 participants in Surabaya, Indonesia. We created correlates between the 175 commonly consumed foods reported in the dietary recalls and the 2007–08 National Health and Examination Survey (NHANES). The correlates were analyzed using the Nutrient Rich Foods index (NRF) 9.3 and an aggregate environmental score (EIS) made up of 4 life cycle assessment (LCA) indicators including land and water use, greenhouse gas emissions, and eutrophication. Results Tofu and tempeh were the only foods that scored above the median in both nutrient quality and environmental impact, indicating a high NRF9.3 and low EIS. Fish and chicken scored above the median in nutrient quality but below the 25th percentile in environmental impact, while eggs scored below the median in both categories. Rice, the most consumed food, scored below the 25th percentile in nutrient quality but above the median in environmental impact. Beef consumption is low compared to other sources of protein. Fruit intake is low compared to other food groups while vegetable consumption is moderately high, with both lying above the 75th percentile in both categories. Conclusions The results highlight that tofu and tempeh may confer the largest benefits in terms of health and environment. Though chicken and fish exhibit high nutrient quality, increased consumption in place of tofu and tempeh may lead to worsened environmental impacts. Funding Sources Harvard T.H. Chan School of Public Health Rose Service Learning Fellowship Grant.

Adherence to DASH dietary pattern is inversely associated with osteoarthritis in Americans

Osteoarthritis (OA) is one of the most common diseases that cause disability among older adults. The objective of this study was to assess the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) and OA in American adults. This study included adults (≥ aged 20 years) who participated in the National Health and Examination Survey (NHANES) 2007–2016 in the United States. Adherence to the DASH score was calculated from 8 food groups. Higher scores indicate better adherence to the DASH dietary pattern. Among the 21,901 participants included in this study, 10.26% reported having OA. Results of our multivariable logistic regression indicated a statistically significant inverse association between DASH score tertiles and OA. The adjusted ORs (95% CI) were 1.00 (ref), 0.89 (0.72; 1.10), and 0.78 (0.60; 1.00) across increasing DASH score tertiles (P for trend = 0.045). In this representative sample of American adults, greater adherence to the DASH dietary pattern was associated with lower likelihood of having OA.