National Health And Nutrition Examination Study Research Articles

Association of blood trihalomethane concentrations with diabetes mellitus in older adults in the US: a cross-sectional study of NHANES 2013-2018.

Previous studies have demonstrated that there is a correlation between trihalomethanes and disease progression, such as allergic diseases. As we know, only few studies focused on the relationship between trihalomethanes and metabolic diseases, such as diabetes mellitus. The aim of this study was to further explore the associations between blood trihalomethane concentrations and diabetes mellitus in older adults in the US. Data were collected from the National Health and Nutrition Examination Study (NHANES) database in the survey cycle during 2013 to 2018, including 2,511 older adults in the US whose blood trihalomethane concentrations were measured, involving chloroform (TCM) and brominated trihalomethanes (Br-THMs). Br-THMs include bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM). Meanwhile, the concentration of total trihalomethanes (TTHMs) was also measured later. A multivariate logistic regression and restricted cubic spline were used to examine the relationship between blood THMs and diabetes mellitus. Meanwhile, we performed a subgroup analysis, which aims to explore the stability of this relationship in different subgroups. In order to further consider the impact of various disinfection by-products on diabetes, we also used weighted quantile sum (WQS). To explore the correlation in trihalomethanes, we plot a correlation heatmap. Adjusting for potential confounders, we found that there was a significant negative association between chloroform and diabetes mellitus [Model 1 (adjusted for covariates including age, sex, and race, OR = 0.71; 95% CI: 0.50-1.02; p = 0.068; p for trend = 0.094); Model 2 (adjusted for all covariates, OR = 0.68; 95% CI: 0.48-0.96; p = 0.029; p for trend = 0.061)]. Inthe bromodichloromethane, we reached a conclusion that is similar to TCM [Model 1 (adjusted for covariates including age, sex, and race, OR = 0.54; 95% CI: 0.35-0.82; p = 0.005; p for trend = 0.002); Model 2 (adjusted for all covariates, OR = 0.54; 95% CI: 0.35-0.82; p = 0.003; p for trend = 0.002)]. Meanwhile, the restricted cubic spline curve also further confirms this result (p overall = 0.0027; p overall< 0.001). Based on the analysis in the subgroups, we found that the value p for interaction in the majority of subgroups is higher than 0.1. Trihalomethanes and diabetes were inversely associated, and in the WQS, chloroform and bromodichloromethane were found to be the major contributors to this relationship. In the correlation analysis, we found that most trihalomethanes have a weak correlation, except for TBM and TCM with a strong correlation. Our results in this study showed that blood chloroform, bromodichloromethane concentrations, and diabetes mellitus in older adults in the US are negatively correlated, suggesting that chloroform and bromodichloromethane can be protective factors for diabetes.

Frequency of Cannabis Use and Female Infertility: A Cross-Sectional Analysis [ID 2683566

INTRODUCTION: With expanding cannabis legalization in the United States, the prevalence of cannabis use is growing. Literature describing the effect of cannabis use on fertility is limited. The purpose of this study is to investigate the association between frequency of cannabis use and infertility. METHODS: This study utilized cross-sectional data from the 2013–2018 cycles of the National Health and Nutrition Examination Study (NHANES) for women aged 20–49. We used multivariable logistic regression models to examine the association between frequency of cannabis use (never used, irregular use, regular use) and infertility (inability to conceive within 1 year), adjusting for self-reported sociodemographics and use of other substances. Regular cannabis use was defined as monthly use or more for at least a year. All analyses were conducted using R, version 2022.07.2. RESULTS: Of the 3,166 women included, 12.5% reported infertility, with the prevalence of infertility ranging from 10.8% among irregular cannabis users to 15.4% among regular cannabis users. Compared to women who reported never using cannabis, women who reported regular use had 47% greater odds of infertility (adjusted odds ratio [aOR] 1.47; 95% CI, 0.88, 2.45) and women who reported irregular use had 17% lower odds of infertility (aOR 0.83; 95% CI, 0.54, 1.30). CONCLUSION: Our results contribute to a small, but growing body of evidence that regular cannabis use could have a small to moderate association with infertility, signaling that further research is necessary to better characterize the risk to prospective parents.

Secular Trends in Central Nervous System-Active Polypharmacy Among Serial Cross-Sections of US Adults, 2009-2020.

Data comprehensively examining trends in central nervous system (CNS)-active polypharmacy are limited. The objective of this cross-sectional study was to characterize the composition of and trends in CNS-active medication use in US adults. We included all participants ≥ 18 years old in the National Health and Nutrition Examination Study (NHANES), 2009-2020. The primary outcome was the percent of adults with CNS-active polypharmacy. This was defined as ≥ 3 medications among antidepressants [tricyclic, selective and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs), opioids, antiepileptics, antipsychotics, benzodiazepines, and nonbenzodiazepine receptor agonists ("Z-drugs")]. Secondary outcomes included prevalence of any CNS-active medication and specific medications and classes over time, and their indications. Percentages were weighted according to NHANES's nationally representative sampling frame. log binomial regressions evaluated the relative risk (RR) for each outcome, comparing the last (2017-2020) versus the first (2010-2011) survey cycle. We included 34,189 adults (18.8% at least 65 years old) from five serial cross-sections (survey cycles). The prevalence of CNS-active polypharmacy was 2.1% in 2009-2010 and 2.6% in 2017-2020 [RR 1.18, 95% confidence interval (CI) 0.94-1.47]. The prevalence of CNS-active polypharmacy did not significantly change within any specific age group (e.g., age at least 65 years: RR 1.29, CI 0.74-2.24). The prevalence of any CNS-active medication was 21.0% in 2009 and 24.6% in 2017-2020 (RR] 1.12, 95% CI 1.02-1.25). A substantial increase occurred for antiepileptics (5.1-8.3%), specifically among participants aged 65 years and older (8.3-13.7%). This was largely driven by increasing gabapentin prevalence (1.4-3.6% overall; 3.3-7.9% age 65 years and older). Anticholinergic, SSRIs/SNRIs, antiepileptics, and benzodiazepines were elevated in most cycles for participants at least 65 years old compared with participants less than 65 years, and opioid use was increased in several cycles for older participants as well. Alprazolam was the most common benzodiazepine and third most common medication for anxiety/depression. Gabapentin was the most common CNS-active medication (3.6% of all participants in 2017-2020), followed by sertraline, citalopram, and acetaminophen-hydrocodone (each ~2%). The most common categories were antidepressants (13.7% in 2017-2020), followed by opioids (5.1% in 2017-2020). CNS-active medications are increasingly common, particularly gabapentin, and use of any CNS-active medication increased by 12%. Numerous CNS-active classes also increased in older adults throughout the years. Increasing suboptimal medication use highlight the need for further investigation into causes for potentially inappropriate prescribing, particularly for older adults.

Developing and validating a nomogram for cognitive impairment in the older people based on the NHANES.

To use the United States National Health and Nutrition Examination Study (NHANES) to develop and validate a risk-prediction nomogram for cognitive impairment in people aged over 60 years. A total of 2,802 participants (aged ≥ 60 years) from NHANES were analyzed. The least absolute shrinkage and selection operator (LASSO) regression model and multivariable logistic regression analysis were used for variable selection and model development. ROC-AUC, calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram's performance. The nomogram included five predictors, namely sex, moderate activity, taste problem, age, and education. It demonstrated satisfying discrimination with a AUC of 0.744 (95% confidence interval, 0.696-0.791). The nomogram was well-calibrated according to the calibration curve. The DCA demonstrated that the nomogram was clinically useful. The risk-prediction nomogram for cognitive impairment in people aged over 60 years was effective. All predictors included in this nomogram can be easily accessed from its' user.

Demographic, Healthcare Access, and Dietary Factors Associated With Thyroid Hormone Treatments for Hypothyroidism.

Clinical guidelines have recommended a trial of liothyronine (LT3) with levothyroxine (LT4) in select patients with hypothyroidism. However, little is known about the real-world use of LT3 and desiccated thyroid extract (DTE) and the characteristics of patients treated with LT3 and DTE. (1) Determine national trends of new LT4, LT3, and DTE prescriptions in the United States; (2) determine whether sociodemographic, healthcare access, and dietary factors are associated with different thyroid hormone (TH) therapies. Parallel cross-sectional studies were conducted using 2 datasets: (1) a national patient claims dataset (2010-2020) and (2) the National Health and Nutrition Examination Study (NHANES) dataset (1999-2016). Included participants had a diagnosis of primary or subclinical hypothyroidism. Study outcomes included the impact of demographics and healthcare access on differences in the proportion of TH therapies consisting of LT4, LT3, and DTE (patient claims) and differences in dietary behaviors between DTE-treated participants and LT4-treated matched controls (NHANES). On an average annual basis, 47 711 adults received at least 1 new TH prescription, with 88.3% receiving LT4 monotherapy, 2.0% receiving LT3 therapy, and 9.4% receiving DTE therapy. The proportion receiving DTE therapy increased from 5.4% in 2010 to 10.2% in 2020. In the analysis between states, high primary care and endocrinology physician densities were associated with increased use of LT4 monotherapy (odds ratio 2.51, P < .001 and odds ratio 2.71, P < .001). DTE-treated NHANES participants (n = 73) consumed more dietary supplements compared to LT4-treated participants (n = 146) (4.7 vs 2.1, P < .001). The proportion of new TH therapies containing DTE for hypothyroidism doubled since 2010 while LT3 therapies remained stable. DTE treatment was associated with decreased physician density and increased dietary supplement use.

The association of healthy eating index with periodontitis in National Health and Nutrition Examination Study 2011-2012.

AimPeriodontitis is a chronic inflammatory disorder caused by periodontopathic bacteria that causes inflammation of the supporting tissues around teeth. Previous studies have found that daily dietary nutritional intake can influence the development of periodontal disease. However, research on the Healthy Eating Index’s involvement in periodontitis is limited. The purpose of this study was to look at the link between the Healthy Eating Index and periodontitis.Methods and designWe examined data from the National Health and Nutrition Examination Study (NHANES), a nationally representative survey that was performed in 2-year cycles from 2011 to 2012. As part of our investigation, we used multivariate logistic regression models to investigate the independent relationship between the Healthy Eating Index and periodontitis. We used odds ratios (OR) with 95% confidence intervals to assess the significance of the connection (95% CI).ResultsIndividuals with a lower total healthy eating index were more likely to have periodontitis. A higher healthy diet index was associated with a lower prevalence of periodontitis (OR = 0.69; 95%CI: 0.49–0.97), according to adjusted multivariate regression models. The restricted cubic spline (RCS) analysis revealed that the non-linear relationship between HEI-2015 and periodontitis was statistically significant and that high HEI-2015 reduced periodontitis prevalence.ConclusionThe study’s findings revealed that dietary structure was linked to the prevalence of periodontitis. Patients with a higher Healthy Eating Index were less likely to have periodontitis. There is a need for future prospective longitudinal studies to confirm causality.

Source apportionment of serum PFASs in two highly exposed communities

Per- and polyfluoroalkyl substances (PFASs) are synthetic chemicals that are ubiquitous in environmental and biological systems, including human serum. PFASs are used in many products and industrial processes and are tied to numerous health effects. Due to multiple sources and exposure pathways, methods are needed to identify PFAS sources in communities to develop targeted interventions. We assessed effectiveness of three source apportionment methods (UNMIX, positive matrix factorization [PMF], and principal component analysis - multiple linear regression [PCA-MLR]) for identifying contributors to human serum PFAS concentrations in two highly exposed populations in Colorado and North Carolina where drinking water was contaminated via upstream sources, including a Space Force base and a fluorochemical manufacturing plant. UNMIX and PMF models extracted three to four potential PFAS exposure sources in the Colorado and North Carolina cohorts while PCA-MLR classified two in each cohort. No sources were characterized in NHANES (National Health and Nutrition Examination Study). Results suggest that these three methods can successfully identify sources in highly exposed populations. Future PFAS exposure research should focus on analyzing serum for an expanded PFAS panel, identifying cohorts with other distinct point source exposures, and combining biological and environmental data to better understand source apportionment results in the context of PFAS toxicokinetic behavior.

Dietary Intake Among US Adults with Food Allergy: Analysis of the National Health and Nutrition Examination Study (NHANES) Survey Data

ObjectivesFood allergy (FA) is a costly, potentially life-threatening condition affecting nearly 11% of the US adult population and can require lifelong avoidance of allergens, but little is known about the dietary patterns of individuals with FA. We aimed to use National Health and Nutrition Examination Study (NHANES) survey data to compare dietary patterns of participants with allergies to cow's milk (CM) or peanuts or tree nuts (PT) to those without FA.MethodsAdult participants in the NHANES 2007–2010 with valid data on self-reported FA were included. Dietary intake was estimated using up to two 24-hour recalls, and Healthy Eating Index 2015 (HEI-2015) was computed to assess diet quality. Analyses were conducted using weights to account for the complex survey design of NHANES.ResultsA total of 10,669 participants were included, of whom 2.7% reported CM allergy and 1.4% PT allergy. Participants reporting CM or PT allergies had higher education (37% vs 27% college or above) and income (mean poverty-income-ratio = 3.3 vs 3.0), were less likely to be current smokers (12% vs 21%) and were more likely to be taking dietary supplements (64% vs 48%) than those with no FA. In comparison to participants with no FA, those with CM allergy were more likely to be females (69% vs 51%) and non-Hispanic white (76% vs 69%), while those with PT allergy were more likely to be non-Hispanic black (15% vs 11%); all p-values < 0.05. Compared to those with no FA, participants with CM allergy had higher HEI scores (56 vs 53, P < 0.01) and lower mean intakes of starchy vegetables (0.4 vs 0.5 cup equivalents (eq)/day, P < 0.01), refined grains (4.9 vs 5.6 ounce (oz) eq/day, P < 0.01), and milks including calcium-fortified soy milk (0.5 vs 0.8 cup eq/day, P < 0.01). In contrast, participants with PT allergy had higher intakes of refined grains (7.1 vs 5.6 oz eq/day, P = 0.049) and sodium (4102 vs 3446 mg/day, P < 0.01) compared to those without FA, while HEI scores were similar. Total energy and macronutrients intake (total proteins, carbohydrates, fats) were similar across the three groups.ConclusionsFood allergy may be associated with shifts in overall diet composition, depending on type of food allergen. More research is needed to characterize these dietary behaviors and assess the types of food substitutions and their potential impacts on health.Funding SourcesNone.

Describing Intersectional Health Outcomes: An Evaluation of Data Analysis Methods.

Background:Intersectionality theoretical frameworks have been increasingly incorporated into quantitative research. A range of methods have been applied to describing outcomes and disparities across large numbers of intersections of social identities or positions, with limited evaluation.Methods:Using data simulated to reflect plausible epidemiologic data scenarios, we evaluated methods for intercategorical intersectional analysis of continuous outcomes, including cross-classification, regression with interactions, multilevel analysis of individual heterogeneity (MAIHDA), and decision-tree methods (classification and regression trees [CART], conditional inference trees [CTree], random forest). The primary outcome was estimation accuracy of intersection-specific means. We applied each method to an illustrative example using National Health and Nutrition Examination Study (NHANES) systolic blood pressure data.Results:When studying high-dimensional intersections at smaller sample sizes, MAIHDA, CTree, and random forest produced more accurate estimates. In large samples, all methods performed similarly except CART, which produced less accurate estimates. For variable selection, CART performed poorly across sample sizes, although random forest performed best. The NHANES example demonstrated that different methods resulted in meaningful differences in systolic blood pressure estimates, highlighting the importance of selecting appropriate methods.Conclusions:This study evaluates some of a growing toolbox of methods for describing intersectional health outcomes and disparities. We identified more accurate methods for estimating outcomes for high-dimensional intersections across different sample sizes. As estimation is rarely the only objective for epidemiologists, we highlight different outputs each method creates, and suggest the sequential pairing of methods as a strategy for overcoming certain technical challenges.

Using a translational research paradigm to investigate dietary intake of fruit juice on per- and polyfluoroalkyl substances (PFAS) concentrations

BACKGROUND AND AIM: Certain fruit juices, such as apple juice (AJ), contain bioactive molecules that can impair intestinal drug absorption through inhibition of transporter Organic Anion Transporting Polypeptide 2B1 (OATP2B1). Because some PFAS have been shown to be OATP2B1 substrates, we used a translational research paradigm to explore our hypothesis that higher fruit juice intake is associated with lower PFAS concentrations. METHODS: Female C57Bl/6 mice were administered perfluorooctane sulfonic acid (PFOS, 5 mg/kg) in buffer or in 4x AJ concentrate, with blood and tissues collected 5 hours after administration. Tissue PFOS was extracted and quantified by LC-MS. Epidemiologic analysis was conducted on 345 adolescents aged 12-19 years and 1,458 adults aged 20-80 years using the National Health and Nutrition Examination Study (NHANES), 2013 - 2014 cycle. Pure (100%) fruit juice intake was assessed by 24h dietary recall. Log-2 transformed serum concentrations of PFOS, perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) were evaluated. Multivariable regression models were used to assess changes in PFAS concentrations in relation to dietary intake of juice, adjusting for covariates. RESULTS:In mice, 4x AJ co-administration decreased PFOS concentrations in blood, liver, kidney, and brain 5 hours after administration, indicating that 4x AJ can inhibit or delay PFOS absorption. Intake of pure fruit juice more than 1 time in the previous 24h was associated with a 15% (95%CI: -28%, -1%) reduction in serum PFOA concentration compared with no intake of juice among adolescents. No associations were observed between fruit juice intake and PFAS concentrations in adults. CONCLUSIONS:Combining experimental and epidemiological data, fruit juice consumption might lower PFAS burden. More research is needed to elucidate the effect of fruit juice consumption on PFAS concentrations in humans across age groups. KEYWORDS: PFAS, juice, translational, exposure reduction

Dietary intake and blood concentrations of folate and folic acid in relation to serum per- and polyfluoroalkyl substances (PFAS) concentrations

BACKGROUND AND AIM: Folate may counteract the effects of environmental chemical exposures. This study aimed to explore the associations of dietary folate and folic acid intake with serum concentrations of per- and polyfluoroalkyl substances (PFAS). METHODS: We included 505 children (aged 3-11), 345 adolescents (aged 12-19), and 1,458 adults (aged 20-80) in the National Health and Nutrition Examination Study (NHANES), 2013 - 2014 cycle. Dietary intake of folate and folic acid in food and supplementation were evaluated by dietary recall in the last 24h and 30 days, respectively. Biomarker concentrations of folate and folic acid in serum and folate in red blood cells were also assessed. We examined serum perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS). Multivariable regression models were used to assess change in log2-transformed PFAS concentrations in relation to dietary intake and folate and folic acid biomarkers, adjusting for covariates. RESULTS:Children’s dietary supplement intake of folic acid was negatively associated with PFOA, PFOS and PFNA concentrations (for example, PFNA: -13%; 95%CI: -29%, 0.07%). In adolescents, significant negative associations were found for folate in red blood cells and all four PFAS concentrations (for example, PFNA: -25%; 95%CI: -43%, -1%); total serum folate concentration and PFNA; and dietary intake of folate in food and PFOA and PFHxS concentrations. In adults, significant negative associations were found for dietary supplement intake of folic acid and serum concentrations of PFOA, PFOS and PFNA (PFNA: -10%; 95%CI: -18%, -2%); folate concentrations in red blood cells and all four PFAS concentrations; as well as serum folic acid and total folate concentrations and PFOA, PFOS and PFNA. CONCLUSIONS:Dietary intake and biomarkers of folate and folic acid were negatively associated with select PFAS concentrations in the U.S. population. These findings may have important implications for reducing PFAS body burden. KEYWORDS: PFAS, folate, folic acid, exposure reduction

Chronic Obstructive Pulmonary Disease is a Risk Factor for Sensorineural Hearing Loss: A US Population Study.

The goal of this study is to determine if chronic obstructive pulmonary disease (COPD) is associated with sensorineural hearing loss (SNHL) in a national database. Cross-sectional study. National sample of the United States population. Adults with audiometric and spirometry data from the National Health and Nutrition Examination Study (NHANES) database. None. A total of 2,464 adults with spirometry and audiometry data from the NHANES database (2009-2012) were studied. Outcome measures included hearing, measured by high-frequency pure tone average (HFPTA; 3, 4, 6, 8 kHz) and low-frequency pure tone average (LFPTA; .5, 1, 2 kHz) frequencies. SNHL was defined as a HFPTA or LFPTA threshold more than 25 decibels (dB) in the better ear. Multivariable regression analyses explored the association between hearing loss and COPD. The prevalence of COPD was 19.8% in individuals with SNHL in the better ear and 4.7% in individuals with normal hearing (p < 0.001). Presence of COPD was associated with elevated hearing thresholds (worse hearing) at each individual frequency. The presence of COPD was independently associated with a 3.29 dB (95% CI: 1.48, 5.09) increase in HFPTA (p < 0.001), and 2.32 dB (1.13, 3.50) increase in LFPTA (p < 0.001) after controlling for medical, social, and environmental covariates. The presence of COPD was independently associated with a 1.85-fold (1.12, 3.06) increased odds of isolated low-frequency SNHL (p = 0.017). COPD was independently associated with sensorineural hearing loss after controlling for multiple confounding factors. These results contribute to the evidence that COPD and pulmonary dysfunction can be comorbid with hearing decline.

The association of sex steroid hormone concentrations with non-alcoholic fatty liver disease and liver enzymes in US men.

This study aimed to analyse the association of sex hormone levels with liver enzyme levels and non-alcoholic fatty liver disease (NAFLD) in a nationally representative sample of men. A total of 919 men from the US National Health and Nutrition Examination Study (NHANES) III were included in this cross-sectional analysis of data from 1988 to 1991. We used existing data on serum total and free testosterone, total and free estradiol, androstanediol glucuronide (AAG) and sex steroid-binding globulin (SHBG), and estimated their associations with aspartate aminotransferase (AST), and alanine aminotransferase (ALT) and NAFLD, as determined using ultrasound, after adjusting for possible confounders including age, race, smoking, alcohol, physical activity, waist circumference and steroid hormones. Lower total testosterone (TT) and higher free estradiol were associated with higher odds of NAFLD after adjusting for confounders including the other sex hormones. Lower TT was associated with higher odds of elevated AST, but not ALT. Free testosterone, total estradiol, SHBG and AAG were not associated with NAFLD or liver enzymes. This study supports an inverse association between TT concentration and NAFLD in men independent of other sex hormones (SHBG, AAG and estradiol) and known risk factors, such as obesity, age and lifestyle. Exploration of whether TT might be a non-invasive marker for NAFLD diagnosis is warranted.

Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Survey

The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aimed to model the progression and asymmetry of hearing loss in the older old using a representative, national database. This was a cross-sectional, multicentered US epidemiologic analysis using the National Health and Nutrition Examination Study (NHANES) 2005-2006, 2009-2010, and 2011-2012 cycles. Subjects included non-institutionalized, civilian adults 80 years and older (n=621). Federal security clearance was granted to access publicly-restricted age data. Outcome measures included pure-tone average air conduction thresholds and the 4-frequency pure tone average (PTA). 621 subjects were 80 years old or older (mean=84.2 years, range=80-104 years), representing 10,600,197 Americans. Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). Compounded over a lifetime, the velocity of hearing loss would increase five-fold, from 0.2 dB loss/year at age 20 to 1 dB loss/year at age 100. This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. There was no change in the asymmetry of hearing loss with increasing age over 80 years (linear regression coefficient of asymmetry over age=0.07 (95% CI=-0.01, 0.24). In conclusion, hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100, becoming near-universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

Mean Combined Relative Grip Strength and Metabolic Syndrome: 2011-2014 National Health and Nutrition Examination Survey.

Churilla, JR, Summerlin, M, Richardson, MR, and Boltz, AJ. Mean combined relative grip strength and metabolic syndrome: 2011-2014 National Health and Nutrition Examination Survey. J Strength Cond Res 34(4): 995-1000, 2020-The purpose of this study was to examine the relationships among mean combined relative grip strength (MCRGS), the metabolic syndrome (MetS), and the individual MetS criterion using a nationally representative sample of U.S. adults (≥20 years of age). The study sample included subjects from the 2011-2014 National Health and Nutrition Examination Study (NHANES). Subject MCRGS, using an average of 3 attempts per hand, was measured by a trained examiner using a handgrip dynamometer. All anthropometric, blood pressure, and serum blood measures used to diagnose the MetS were obtained in a Mobile Examination Center using a subsample of NHANES subjects (N = 4,664). Results suggest a favorable inverse dose-response relationship exists across quartiles of increased MCRGS and likelihood of MetS in both men and women (p < 0.0001 for trend). In analyses adjusted for age, race, education, and meeting aerobic physical activity recommendations, when compared with a referent group in the lowest quartile of MCRGS (MCRGS <2.66 kg/body mass index [BMI] in men; MCRGS <1.58 kg/BMI in women), those in the third (MCRGS >3.20-3.77 kg/BMI in men; MCRGS >1.99-2.38 kg/BMI in women) and fourth quartile (MCRGS >3.77 kg/BMI in men; MCRGS >2.38 kg/BMI in women), were significantly less likely to have the MetS, independent of gender (p ≤ 0.05 for all). Similar findings varied according to individual MetS criterion. These findings provide the first data suggesting that increased MCRGS may be inversely related to the MetS or the individual MetS criterion in a nationally representative sample of U.S. adults.

Glucose Metabolism in Sickle Cell Disease

Background. Whether glucose metabolism differs in sickle cell anemia (SCA) patients versus controls is not clear. Transfusional iron overload and Inflammation might enhance glucose intolerance, while lower BMI and increased hypoxic responses might be protective. Methods: We prospectively determined indicators of glucose metabolism in 46 African-American hemoglobin SS or S/β0-thalassemia subjects &gt;35 years of age who did not have the diagnosis of DM, and examined the relationship of these parameters to BMI and serum ferritin concentration. We compared the SCA subjects to 46 African-American controls from the National Health and Nutrition Examination Study (NHANES) who did not have the diagnosis of DM and were matched by age, sex, BMI and serum ferritin to the SCA subjects. Results: The BMI was &gt;25 kg/m2 in 23 SCA subjects (48%) and the serum ferritin was &gt;300 ng/ml in 30 (65%) consistent with increased body iron stores. The fasting blood glucose was &gt;125 mg/dL in 3 of 46 SCA subjects (6.5%) suggesting unsuspected DM. The fasting glucose concentration independently correlated with serum ferritin concentration (r=0.336, P=0.024) and the fasting insulin level correlated independently with both BMI (r=0.583, P=0.00002) and serum ferritin (r=0.300, P=0.016). Measures of glucose metabolism did not differ significantly between the SCA subjects and NHANES controls, even though the SCA subjects had lower blood pressures, WBC counts and blood lipid levels. Conclusions: Measures of glucose metabolism in older SCA patients are similar to controls matched for BMI and iron status despite marked differences in blood pressure, hemoglobin, WBCs and blood lipid levels. Disclosures Gordeuk: Inctye: Research Funding; CSL Behring: Consultancy, Honoraria, Research Funding; Ironwood: Research Funding; CSL Behring: Consultancy, Honoraria, Research Funding; Imara: Research Funding; Emmaus: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Research Funding; Inctye: Research Funding; Modus Therapeutics: Consultancy, Honoraria; Pfizer: Research Funding; Pfizer: Research Funding; Global Blood Therapeutics: Consultancy, Honoraria, Research Funding; Ironwood: Research Funding; Imara: Research Funding.

Epidemiologic evaluation of Nhanes for environmental Factors and periodontal disease

Periodontitis is a chronic inflammation that destroys periodontal tissues caused by the accumulation of bacterial biofilms that can be affected by environmental factors. This report describes an association study to evaluate the relationship of environmental factors to the expression of periodontitis using the National Health and Nutrition Examination Study (NHANES) from 1999–2004. A wide range of environmental variables (156) were assessed in patients categorized for periodontitis (n = 8884). Multiple statistical approaches were used to explore this dataset and identify environmental variable patterns that enhanced or lowered the prevalence of periodontitis. Our findings indicate an array of environmental variables were different in periodontitis in smokers, former smokers, or non-smokers, with a subset of specific environmental variables identified in each population subset. Discriminating environmental factors included blood levels of lead, phthalates, selected nutrients, and PCBs. Importantly, these factors were found to be coupled with more classical risk factors (i.e. age, gender, race/ethnicity) to create a model that indicated an increased disease prevalence of 2–4 fold across the sample population. Targeted environmental factors are statistically associated with the prevalence of periodontitis. Existing evidence suggests that these may contribute to altered gene expression and biologic processes that enhance inflammatory tissue destruction.

Children’s exposures to lead and cadmium: FDA total diet study 2014-16

ABSTRACTChildren are at potential risk for adverse effects from lead and cadmium exposures due to the effects of these elements on developing brains. Children’s dietary exposures to lead and cadmium were estimated based on lead and cadmium concentration data from FDA’s Total Diet Study (TDS) and on food consumption data from What We Eat In America (WWEIA), the food survey portion of the National Health and Nutrition Examination Study (NHANES). Estimated mean exposures vary based on age range (1–3 y, 4–6 y, or 1–6 y) and on substitution scenarios for values below the limit of detection (non-detects = 0; non-detects = limit of detection; hybrid approach). Estimated mean lead exposures range from 1 to 3.4 µg/day, with major contributions from grains, fruit, dairy, and mixtures (e.g. hamburgers, pizza, lasagna, soups). Estimated mean cadmium exposures range from 0.38 to 0.44 µg/kg bw/day, with major contributions from grains, mixtures, and vegetables. Estimated children’s lead exposures declined slightly since 2004–08, but cadmium exposures did not decline. No safe level has been identified for lead exposures, and toxicologic reference values for cadmium range from 0.1 to 0.83 µg/kg bw/day. The data on lead and cadmium exposures, and on contributors to exposures, will inform research and regulatory priorities on mitigation of exposures to lead and cadmium.

Prevalence of false-positive hepatitis C antibody results, National Health and Nutrition Examination Study (NHANES) 2007–2012

BackgroundScreening large numbers of persons in a population with low prevalence of a disease leads to many false-positives. However, populations with low HCV prevalence may sometimes be recommended for HCV screening, for instance patients or healthcare workers after a possible healthcare-related exposure. ObjectivesWe determined the percentage of true vs false-positive HCV antibody (anti-HCV) test results among 2007–2012 participants in the National Health and Nutrition Examination Study (NHANES), a nationally representative study with approximately 1% HCV infection prevalence, much lower than in groups typically recommended for HCV screening. Study designAnti-HCV test confirmation was performed using a recombinant immunoblot assay (RIBA) test and follow-up HCV RNA testing. ResultsOverall, of 22,359 NHANES participants tested, 479 (2%) were anti-HCV screening reactive and 477 were tested for RIBA; of these 323 (68%) confirmed as true positive and 105 (22%) were false-positives. Many others (49, 10%) were RIBA indeterminate and likely false-positive. Because of these false positive tests, the overall prevalence of chronic infection among those testing anti-HCV screening reactive was much lower (218, 51%) than would be expected due to disease clearance alone (approximately 80%). ConclusionsAll screening anti-HCV positive tests should be followed by an HCV RNA test, in order to confirm whether the patient has current infection so that infected persons can be referred to care and treatment to avoid the significant morbidity and mortality associated with chronic HCV infection.

Commentary: Antidepressants and diabetes risk: why are there discrepant findings from cohort studies based on patient records and those based on serial phenotyping?

Commentary: Antidepressants and diabetes risk: why are there discrepant findings from cohort studies based on patient records and those based on serial phenotyping?