National Health And Nutrition Examination Survey Study Research Articles

The association between fatty acid intake and breast cancer based on the NHANES and Mendelian randomization study

BackgroundObservational studies have examined the association between fatty acid intake and breast cancer (BC), and the association might vary depending on menopausal status, but the results remain controversial. The objective of this study was to investigate the associations between fatty acid intake and BC. MethodsThe National Health and Nutrition Examination Survey (NHANES) 1999–2016 was used in the study, and stratified analysis by menopausal status was performed. Logistic regression models were used to evaluate the associations between BC and intake of saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs), adjusting for covariates. Three two-sample Mendelian randomization (MR) methods—inverse variance weighted (IVW), weighted median, and Mendelian randomization–Egger (MR-Egger) regression—were applied to further verify the associations between intake of fatty acids and BC. ResultsHigher intake of MUFAs was associated with lower risk of BC in premenopausal women: ORs (95 %CI): 0.325 (0.110, 0.964). IVW showed that increased intake of MUFAs was associated with a reduced risk of BC: 0.997 (0.995, 1.000), p = 0.024. No associations between BC and SFAs, MUFAs or PUFAs were found in postmenopausal women or in the overall population. ConclusionsIncreasing intake of MUFAs might reduce the risk of BC in premenopausal women. The protective effect of MUFAs on BC was also supported by MR study.

The prevalence and characteristics of adults with latent tuberculous infection in the United States and the implications for healthcare in Texas

The Centers for Disease Control and Prevention reported 8,916 cases of tuberculosis in 2019. Reducing the number of cases of active tuberculosis requires identification of patients with latent tuberculous infections (LTBI). Optimal screening for LTBI requires information about the demographics and characteristics of people who are more likely to have had tuberculous infection. Information from the 2011–2012 National Health and Nutrition Examination Survey (NHANES) was used to determine the number and characteristics of adults from a representative sample of the United States who had LTBI. Latent tuberculous infection was identified either by a positive skin test or by a positive QuantiFERON blood test. Information about the number of patients with active tuberculosis in Texas was determined from reports from the Texas State Department of Health Services. The NHANES database for the years 2011-2012 included 5,684 adults. Participants with a positive QuantiFERON blood test were more likely in the age group 45-64, male, foreign born, and have less than a high school education. Participants with a positive skin test had similar characteristics. Participants who had both a positive skin test and positive QuantiFERON test were more likely to be in the age group 45-64, males, foreign born, and Hispanic. In addition, they had diabetes, self-reported fair/poor health, and an educational level less than high school. In the State of Texas tuberculosis occurred more frequently in individuals older than 75 who were male and were not US born Texas residents. Important clinical diagnoses included diabetes, alcohol abuse, correctional facility residence, non-injection drug use, positive HIV status, and homelessness. Information from the NHANES study and from the State Department of Health Services in Texas provides information needed to develop screening programs for latent tuberculosis and active tuberculosis.

Biomarker association with cardiovascular disease and mortality – The role of fibrinogen. A report from the NHANES study

BackgroundWhile fibrinogen is a known cardiovascular disease (CVD) risk marker, its quantitative input to mortality risk is a topic of debate. MethodsWe investigated the contribution of fibrinogen, among that of other biomarkers, to prevalent CVD and incident CVD mortality in 4487 participants of the US National Health and Nutrition Examination Survey (NHANES). Participants were observed for a median period of 14 years, resulting in more than 58,000 person-years. ResultsAt baseline 551 participants had CVD and during follow up, 1339 all-cause deaths occurred, 321 (24%) of which were due to CVD. Hierarchical cluster analysis and principal component analysis (PCA) were performed to derive clusters of association between biomarkers. Next, structural equation modelling was performed to investigate the association of these clusters with baseline CVD and all-cause and CVD mortality during follow-up. Mediation analysis was used to determine which biomarkers played a mediatory role between prevalent CVD and future mortality. Fibrinogen clustered with C-reactive protein only and was associated with CVD at baseline (p < 0.0001) and with all-cause (p < 0.001) and CVD (p < 0.001) mortality at follow-up. Only fibrinogen (4.7%), followed by gamma-glutamyl transferase (GGT) (3.5%) and uric acid (2.3%) were identified as possible mediators between CVD status and all-cause mortality, with fibrinogen (3.2%) and GGT (3.1%) the only mediators between CVD status and CVD mortality. ConclusionThis data shows that fibrinogen is not only cross-sectionally associated with CVD, but also contributes to all-cause and CVD mortality at follow-up. It furthermore appears to mediate the association between prevalent CVD and both all-cause and CVD mortality.

Predicting the handgrip strength across the age span: Cross-validating reference equations from the 2011 NIH toolbox norming study

Study DesignThis is a cross-sectional observational study. BackgroundReference equations for describing hand-grip strength across the age span were derived from the 2011 NIH Toolbox norming study. PurposeThe purpose of this study was to cross-validate reference equations by evaluating its predicting power on a separate, independent data set from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) study MethodsObserved hand-grip strength data from 13,676 noninstitutionalized participants were obtained from the NHANES study. Best values (best from 3 trials) and the mean values (averaged from 3 trials) were determined for each hand. Using the age (yr), height (m), and weight (kg), we computed predicted grip strength values for dominant and nondominant hands using the reference equations. For validation, three predictability measures: the correlation coefficient, residuals, and accuracy, were used along with the Bland-Altman plot. ResultsThe predicted values highly correlated with observed values (r = 0.90, ICC = 0.89). In predicting best values, means (SD) of residuals were 1.41 (5.57) and 1.03 (5.44) kg for dominant and nondominant hands, respectively. In predicting mean values, means (SD) of residuals were −0.23 (5.42) and −0.54 (5.31) kg for dominant and nondominant hands, respectively. Root mean square error ranged from 4.10 (female's nondominant mean values) to 6.74 (male's dominant best values). About 5.56% fell outside of the 95% confidence interval of the prediction. ConclusionsWe acknowledged that the two studies' hand-grip protocols (NIH Toolbox, NHANES) were different. Results provided the preliminary predicting performance of the reference equations derived from the NIH Toolbox study.

A Comparison of Metabolic Outcomes Between Obese HIV-Exposed Uninfected Youth From the PHACS SMARTT Study and HIV-Unexposed Youth From the NHANES Study in the United States.

Metabolic perturbations in HIV-exposed uninfected (HEU) obese youth may differ from those in the general obese pediatric population. Metabolic parameters of obese (body mass index Z-score >95th percentile) HEU youth in the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring of ART Toxicities (SMARTT) study were compared with a matched sample of obese youth from the US National Health and Nutrition Examination Survey (NHANES). We evaluated systolic and diastolic hypertension (blood pressure ≥90th percentile for age, sex, and height), total cholesterol >200 mg/dL, high-density lipoprotein cholesterol <35 mg/dL, low-density lipoprotein cholesterol >130 mg/dL, triglycerides (TGs) >150 mg/dL, and Homeostatic Model Assessment-Insulin Resistance >4.0. Modified Poisson regression models were fit to quantify the prevalence ratio (PR) of each outcome comparing the 2 cohorts, adjusting for confounders. The blood pressure outcome analytic subgroup included 1096 participants (n = 304 HEU), the total cholesterol and high-density lipoprotein cholesterol subgroup 1301 participants (n = 385 HEU), and the low-density lipoprotein cholesterol, TG, and Homeostatic Model Assessment-Insulin Resistance subgroup 271 (n = 83 HEU). After adjustment, obese HEU youth had a higher prevalence of systolic and diastolic hypertension [PR = 3.34, 95% confidence interval (CI): 2.48 to 4.50; PR = 2.04, 95% CI: 1.18 to 3.52, respectively], but lower prevalence of insulin resistance (PR = 0.67, 95% CI: 0.54 to 0.85) and hypercholesterolemia (PR = 0.67, 95% CI: 0.44 to 1.01) compared with obese NHANES youth. In the United States, obese HEU youth seem to have an increased risk of hypertension, but lower risk of insulin resistance and hypercholesterolemia, compared with a general obese pediatric population. Monitoring for cardiovascular morbidity in adulthood may be warranted in HEU children.

Evidence on the Validity of a Comprehensive Health Risk Index and Implications for Ambulatory Care and Population Health Management.

A novel, comprehensive health risk index for adults has been validated and is now ready for use to improve the health of individuals and populations. This health risk index provides an estimate of the avoidable risk of death for adults 30 years or older. It includes 12 evidence-based clinical and behavioral risk factors and was validated on discrimination and calibration using the NHANES (National Health and Nutrition Examination Survey) and Framingham Heart Study cohorts. The results from both cohorts were consistent and similar. Discrimination was good, and calibration was acceptable but tended to overpredict mortality risk for females in the higher-risk deciles.

Alpha- and Gamma-Tocopherol and Telomere Length in 5768 US Men and Women: A NHANES Study.

Antioxidants have a number of potential health benefits. The present investigation was designed to determine the relationship between serum alpha- and gamma-tocopherol levels (powerful antioxidants), and leukocyte telomere length (a biomarker of biological aging). A cross-sectional design was employed to study 5768 adults from the National Health and Nutrition Examination Survey (NHANES). DNA was obtained via blood samples. Telomere length was assessed using the quantitative polymerase chain reaction method. Serum concentrations of alpha- and gamma-tocopherol were measured using high performance liquid chromatography (HPLC). Results showed that for each one-year increase in age, telomeres were 15.6 base pairs shorter (F = 410.4, p < 0.0001). After adjusting for differences in the demographic covariates, for each µg/dL higher level of gamma-tocopherol, telomeres were 0.33 base pairs shorter (F = 7.1, p = 0.0126). Telomeres were approximately 1 year shorter (15.6 base pairs) for each increment of 47.3 to 55.7 µg/dL of gamma-tocopherol in the blood, depending on the variables controlled. Adults at the 75th percentile of gamma-tocopherol had 2.8–3.4 years greater cellular aging than those at the 25th percentile, depending on the covariates in the model. However, alpha-tocopherol was not related to telomere length. Evidently, gamma-tocopherol levels, but not alpha-tocopherol, account for meaningful increases in biological aging.

Association of Inflammatory Bowel Disease (IBD) with Depressive Symptoms in the United States Population and Independent Predictors of Depressive Symptoms in an IBD Population: A NHANES Study.

Background/AimsThere is a paucity of population-based studies on the association between inflammatory bowel disease (IBD) and depression in the U.S. population. We sought to study this association using the National Health and Nutrition Examination Survey (NHANES) database.MethodsWe used NHANES data from 2009 to 2010. Our study included 190,269,933 U.S. adults without IBD and 2,325,226 with IBD. We sought to determine whether IBD is an independent risk factor for depressive symptoms (DS) in the U.S. population and studied the independent predictors of DS in IBD population.ResultsDS was present in 49% of the IBD population versus 23% of the non-IBD population (p<0.001). During the multivariate analysis, we found that IBD was independently associated with DS in the U.S. population (p=0.002). The independent predictors of DS in the IBD population were older age (p=0.048) and divorced/separated/widowed status (p=0.005). There was nonsignificant increase in suicidal risk in IBD population with DS versus that in non-IBD population with DS (27% vs 12%, respectively, p=0.080). Only 36% of IBD individuals with DS visited mental health professional or psychiatrist within the past year.ConclusionsIBD is independently associated with DS in the U.S. population. Further research is warranted on risk stratification, screening and management of those with IBD who are at risk of depression.

Diabetes and cardiorenal syndrome: Understanding the “Triple Threat”

ObjectiveDiabetes is known to be associated with chronic kidney disease (CKD) and cardiovascular disease (CVD) independently. Type 2 cardiorenal syndrome (CRS), a recently defined syndrome, is characterized by primary renal failure that progressively leads to cardiac dysfunction. The effect of diabetes on cardiorenal syndrome has not been explored in a multi-ethnic population. In this retrospective secondary analysis, the hypothesis that diabetes modifies the effect of CVD on CKD was tested. MethodsThe National Health and Nutrition Examination Survey (NHANES) is a cross-sectional survey that was performed on the non-institutionalized population in the United States. All patients from the NHANES study, who were 20 years and older between the years 1999 and 2010, were included in the analysis. CKD was determined using the Cockcroft-Gault equation. The analysis was performed using a complex samples logistic regression to determine the relationship between diabetes and CRS. ResultsThe prevalence of CKD among the population was 9.6% in Non-Hispanic Whites, 8.9% in African-Americans, and 4.5% in Hispanics. The overall unadjusted odds ratio for CKD to no CKD was 6.89 (95% confidence interval [CI], 6.13–7.75, p < 0.001). The adjusted OR was elevated, 2.25 (CI 1.56–3.23, p < 0.001), among individuals with diabetes but was approximately 1.0 (1.43 CI 1.16–1.76, p < 0.05) among patients without diabetes after controlling for medical risk factors and demographic risk factors. ConclusionDiabetes is strongly associated with Type 2 CRS in a nationally representative multi-ethnic population and must be considered when treating patients. Longitudinal studies should further examine this association.

Differences in TV Viewing and Computer Game Playing’s Relationships with Physical Activity and Eating Behaviors among Adolescents: An NHANES Study

ABSTRACTBackground: TV viewing and computer game use may both limit physical activity, but only TV viewing may promote a poorer diet due to exposure to food advertising and availability of the hands for snacking. Purpose: The purpose of this study was to investigate relationships between the different screen times and type 2 diabetes markers among youth. Methods: A sample of 12- to 17-year-olds was obtained from the National Health and Nutrition Examination Survey (NHANES). A mediation analysis was initiated, but the null was retained between the screen time types and oral glucose tolerance test values. Relationships between screen time types and physical activity and diet behaviors were investigated using linear regression and adjustments for multiple comparisons. Results: A one-unit increase in square root–transformed hours spent playing computer games was associated with an increased consumption of 288 calories per day (P = .001), whereas TV viewing was not. Discussion: Computer game users might snack more often during pauses in game play or while watching friends play. Understanding more about US adolescents’ eating during screen time could help address overeating. Translation to Health Education Practice: If other research corroborates these findings, Health Education professionals should promote physical activity among adolescents directly—instead of discouraging screen time—and promote healthy eating among computer game users.

Sugar intake from sugar-sweetened beverage among cancer and non-cancer individuals: the NHANES study

Background: It has been estimated that there are approximately 14.5 million cancer survivors in the United States. One out of every six people over 65 is a cancer survivor. Recently growing evidence suggests a link between sugar-sweetened beverage (SSB) consumption and risk of pancreatic and endometrial cancer, and risk of colon cancer recurrence and mortality among cancer survivors. The objective of this study is to closely evaluate the impact of cancer status and other risk factors on sugar intake from SSBs. Methods: A total of 22,182 adults aged ≥20 years old were analyzed using the National Health and Nutrition Examination Survey (NHANES) 2003–2012 data. The primary outcome is high sugar intake (≥80 g) from SSBs per day. The association between sugar intake from SSB consumption and cancer status was evaluated using weighted logistic regression. Results: Approximately 17% of non-cancer participants and 8% of cancer survivors had high sugar intake from SSBs. However, this cancer group difference was not significant after adjusting for other factors, especially age and gender. Individuals who had high sugar intake from SSB were younger, male (21.7%), Black (23.3%), had education level at high school (20.9%), low income (poverty income ratio ≤1, 23.4%), obese (17.1%), current smokers (26.9%) and non-cancer individuals (16.7%) or cervix cancer survivors (17.1%). After adjusting for demographic factors, a significant association between sugar intake from SSBs and cancer status was not observed except that prostate cancer survivors were less likely to intake sugar from SSBs compared to non-cancer individuals (OR =0.41, 95% CI: 0.22–0.77). Conclusions: In general, cancer survivors consumed less sugars from SSBs compared to non-cancer individuals. However, this difference was primarily due to the differences in age distribution of the cancer and non-cancer groups (mean age, 62 and 45 years old, respectively). Individuals who were younger, male, Black, with lower education, with lower income, obese, and current smokers tended to have high sugar intake from SSBs. Custom intervention of decreasing sugar consumption from SSBs should be conducted for both non-cancer individuals and cancer survivors.

Country of Birth and Variations in Asthma and Wheezing Prevalence, and Emergency Department Utilization in Children: A NHANES Study.

Asthma prevalence and asthma-related healthcare utilization differ across racial/ethnic groups and geographical areas. This study builds on previous research to examine the relationship between country of birth and asthma prevalence and healthcare utilization using a national data set. The National Health and Nutrition Examination Survey (NHANES) Demographic and Questionnaire Files from 2007 to 2012 were used for this study. We used SPSS complex sampling design to estimate the association between country of birth and asthma prevalence, wheezing and emergency department (ED) use. The sample size was 8272 children and adolescents between the ages of 5 and 19years old. US-born children had more reported episodes of wheezing (p=0.024) 95% CI 1.06; 2.54. There was no association between country of birth and asthma and ED use. US-born children and adolescents compared to foreign-born children and adolescents are more likely to have episodes of wheezing.

Associations of objectively assessed physical activity and sedentary time with all-cause mortality in US adults: the NHANES study.

BackgroundSedentary behavior is related to increased mortality risk. Whether such elevated risk can be offset by enhanced physical activity has not been examined using accelerometry data.Materials and MethodsWe examined the relations of sedentary time and physical activity to mortality from any cause using accelerometry data among 1,677 women and men aged 50 years or older from the National Health and Nutrition Examination Survey (NHANES) 2003–2004 cycle with follow-up through December 31, 2006.ResultsDuring an average follow-up of 34.67 months and 4,845.42 person-years, 112 deaths occurred. In multivariate Cox proportional hazard models, greater sedentary time (≥ median of 8.60 hours/day) was associated with increased risk of mortality from any cause (relative risk (RR) = 2.03; 95% confidence interval (CI) = 1.09-3.81). Low level of moderate to vigorous physical activity (< median of 6.60 minutes/day) was also related to enhanced all-cause mortality risk (RR = 3.30; 95% CI = 1.33-8.17). In combined analyses, greater time spent sedentary and low levels of moderate to vigorous physical activity predicted a substantially elevated all-cause mortality risk. As compared with the combination of a low sedentary level and a high level of moderate to vigorous physical activity, the risks of mortality from all causes were 4.38 (95% CI = 1.26-15.16) for low levels of both sedentary time and physical activity, 2.79 (95% CI = 0.77-10.12) for greater time spent sedentary and high physical activity level, and 7.79 (95% CI = 2.26-26.82) for greater time spent sedentary and low physical activity level. The interaction term between sedentary time and moderate to vigorous physical activity was not statistically significant (p = 0.508).ConclusionsBoth high levels of sedentary time and low levels of moderate to vigorous physical activity are strong and independent predictors of early death from any cause. Whether a high physical activity level removes the increased risk of all-cause mortality related to sedentariness requires further investigation.

Habitual Physical Activity and Exercise Patterns in Children and Adolescents with Sickle Cell Disease

Background Sickle cell disease (SCD) and its complications have a major impact on physical functioning in affected children and adolescents. However, little is known about habitual physical activity patterns and exercise routines in this population. The aims of this study were to evaluate the amount of time spent in moderate (MPA) or vigorous (VPA) physical activity, examine participation in school-based physical education or organized sports, and explore factors that influence physical activity or exercise habits in children and adolescents with SCD.Methods A58-question, self-administered survey was given to a cross-sectional group of children with SCD (all genotypes) in grades 6 through 12 followed in the Comprehensive Sickle Cell Programs at Ann & Robert H. Lurie Children’s Hospital of Chicago and the University of Illinois at Chicago. Children on hydroxyurea therapy and chronic transfusions were included. The survey included 2 sections: 1) questions adapted from the National Health and Nutrition Examination Survey (NHANES) Physical Activity Questionnaire and 2) supplemental questions addressing participation in school-based physical education and organized sports; disease severity and impact on physical activity; and attitudes about physical activity and exercise. We performed standard descriptive analyses and bivariate analysis using Pearson’s chi-square or Student’s t-test for independent samples for comparison of categorical and continuous data, respectively. Responses from NHANES questions were compared to age, sex and race matched data collected from the 2009-2010 NHANES survey.Results A total of 88 surveys have been collected to date. Among respondents with SCD, 59% were between 11 and 15 years old, 51% were male, 66% had hemoglobin SS disease, 44% were on hydroxyurea and 19% were on chronic transfusions. Data were compared to extracted data from 1362 NHANES participants weighted to adjust for differences in distributions in age, sex and race between groups. The proportion of children with SCD who reported at least 10 minutes of VPA in a typical week (66 vs. 65%, p = 0.91) and their frequency of VPA (2.8 vs. 2.5 days per week, p = 0.44) did not differ from that of children from the NHANES cohort. However, a higher proportion of children with SCD reported MPA (67 vs. 42%, p < 0.001) with a frequency (2.3 vs. 1.4 days per week, p < 0.001) that was significantly higher than that reported in NHANES. The duration of VPA or MPA on a typical day also differed significantly between groups. Compared to children from NHANES, fewer children with SCD reported spending more than 60 minutes in VPA or MPA on a typical day. Overall, only 13% of children with SCD met US physical activity guidelines recommending at least 60 minutes of physical activity every day. Of those children with SCD surveyed, 47% reported participating in school-based sports teams or physical activity clubs and 74% reported participating in physical education when offered at their school. Finally, we examined those variables that were associated with physical activity and participation in organized sports or physical education in children with SCD. Children 11 to 15 years old, when compared to children greater than 15 years old, were more likely to report 60 min of physical activity on more than 2 days per week (73 vs. 27%, p < 0.05). However, neither age nor sex affected participation in organized sports or physical education. We found that physical activity and participation in organized sports or physical education were not significantly affected by respondent beliefs regarding the impact of SCD on enjoyment of those activities. Sickle cell genotype, hydroxyurea use, chronic transfusions, and parental and personal attitudes toward physical activity also had no influence on participation in physical activity, organized sports or physical education in children with SCD.Conclusions When compared to matched peers in the NHANES study, children with SCD participate in comparable levels of VPA and even exceed their peers in levels of MPA. Participation in school-based organized sports and physical education was also common in children with SCD despite the previously reported impact of SCD on physical functioning in this population. Further studies are needed to determine the safety and potential health benefits of regular exercise and athletic participation in this population. DisclosuresNo relevant conflicts of interest to declare.

Abstract 278: Risk factors and prevalence of genital HPV infection among adult females in US between 2003-2010: Data from NHANES study

Abstract Background: More than 50% of sexually active individuals are infected with human papilloma viruses (HPV). Patients with high-risk type HPV infection are at risk for developing cervical cancer later in their life. Several social, demographic and behavioral factors are associated with HPV infection. Our study estimates the prevalence of genital HPV infection and explores the risk factors associated with HPV infection. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) for the years 2003-2010 was used in this study. These surveys included interviews and laboratory measurements. Around 20,000 females aged 18-59 years were included. Data management and statistical analyses were conducted using SAS software 9.3 and SAS callable SUDAAN 11.0.1. Results: The weighted prevalence of HPV infection was 42.9%. Black females had the highest prevalence of HPV infection (60.2%). In a univariate analysis, smoking, drug use, insurance status, age at first sexual contact, number of sexual partners, condom use, and sexual orientation were all associated with HPV infection. In a multivariate analysis, after adjusting for other factors (e.g. country of birth, routine places for healthcare) age, race, level of education, being in a married relation, number of sexual partners and condom use were all significant factors affecting the risk of HPV infection. Age at first sexual encounter and sexual orientation were found to be no longer significant. Non-Hispanic (NH) blacks are 1.73 times more likely to get HPV as compared to NH whites. Age is negatively associated with the risk of HPV infection, except for a second peak between 45-49 years. Participants with only high school degree are at a 30% increased risk of HPV infection compared to college-educated women. Never married (OR=1.89) or divorced or separated (OR=2.4) women have an increased risk of being infected with HPV. HPV infection is 3.7 times more likely for women who have had &amp;gt;11 partners as compared to women with 0-1 partners. Women who have sex without a condom half the time are at a 47% increased risk for contracting HPV as compared to women who have sex with a condom at all times. Conclusions: We estimate that 42.9% of females aged 18-59 years have genital HPV infection. There is a compelling need to implement measures to prevent further HPV infections. Health education and promotion should focus on limiting the number of sexual partners and encouraging safe sexual practices including the use of condoms. Vaccinating females against HPV at an early age will not only help reduce the rate of infection but also prevent cervical cancer development in the future. It will be necessary to continue monitoring the prevalence of HPV in the general population to provide basis for intervention through vaccination as well as by promoting healthy behaviors in the target population, policy changes and resource allocation. Citation Format: Srinivas S. Devarakonda, Amarendra Neppalli, Lihong Liu, Ellen Friday, Runhua Shi. Risk factors and prevalence of genital HPV infection among adult females in US between 2003-2010: Data from NHANES study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 278. doi:10.1158/1538-7445.AM2014-278

Variable patterns of obesity and cardiometabolic phenotypes and their association with lifestyle factors in the Di@bet.es study

Background and aimPrevalence rates of “metabolically healthy obese” (MHO) subjects vary depending on the criteria used. This study examined the prevalence and characteristics of MHO subjects and metabolically abnormal normal-weight subjects and compared the findings with the NHANES 1999–2004 study. The aims of the present study were, first, to determine the prevalence rates of MHO and MNHNO subjects using the same criteria as those of the National Health and Nutrition Examination Survey (NHANES) (1999–2004) study, and second to compare the prevalence and correlates of obese subjects who are resistant to the development of adiposity-associated cardiometabolic abnormalities (CA) and normal-weight individuals who display cardiometabolic risk factor clustering between the Spanish and the US populations. Methods and resultsDi@bet.es study is a national, cross-sectional population-based survey of 5728 adults conducted in 2009–2010. Clinical, metabolic, sociodemographic, and anthropometric data and information about lifestyle habits, such as physical activity, smoking habit, alcohol intake and food consumption, were collected. Subjects were classified according to their body mass index (BMI) (normal-weight, <25 kg/m2; overweight, 25–29.9 kg/m2; and obese, >30 kg/m2). CA included elevated blood pressure; elevated levels of triglycerides, fasting glucose, and high-sensitivity C-reactive protein (hs-CRP); and elevated homeostasis model assessment of insulin resistance (HOMA-IR) value and low high-density lipoprotein cholesterol (HDL-c) level. Two phenotypes were defined: metabolically healthy phenotype (0-1 CA) and metabolically abnormal phenotype (≥2 CA). The prevalence of metabolically abnormal normal-weight phenotype was slightly lower in the Spanish population (6.5% vs. 8.1%). The prevalence of metabolically healthy overweight and MHO subjects was 20.9% and 7.0%, respectively, while in NHANES study it was 17.9% and 9.7%, respectively. Cigarette smoking was associated with CA in each phenotype, while moderate physical activity and moderate alcohol intake were associated with being metabolically healthy. Olive oil intake was negatively associated with the prevalence of CA. ConclusionsSmoking, physical activity level, and alcohol intake contribute to the explanation of the prevalence of CA in the Spanish population, as in the US population. However in Spain, olive oil intake contributes significantly to the explanation of the variance in the prevalence of CA.

Associations between objectively-measured sedentary behaviour and physical activity with bone mineral density in adults and older adults, the NHANES study

BackgroundLack of physical activity (PA) is an important modifiable risk factor for bone mineral density (BMD). Time spent in sedentary behaviour (SB), or time spent in non-exercising seated and reclining postures, has recently emerged as a new public health risk, independent of the amount of time someone spends being active. As national surveys report that adults spend on average 8h per day being sedentary, rising to 10h a day in older age, it has been hypothesised that a repeated exposure to sitting in modern daily life, whether it is for travelling, working or leisure, might have a deleterious effect on bone health in a way that mirrors the results of studies into the effect of lengthy periods of bed-rest. The aim of this study was to investigate for the first time a) how time spent in SB is associated with bone mineral density (BMD), b) whether this association changes depending on the amount of time spent engaging in different intensity levels of PA, and c) if the pattern of accumulation of SB and long uninterrupted periods of SB are associated with BMD. MethodsThe 2005/2006 National Health and Nutrition Examination Survey (NHANES), is a cross-sectional study of a representative sample of the US population that is conducted biannually by the National Centers for Disease Control. PA and SB were assessed objectively over 7days using an Actigraph accelerometer and BMD was measured via dual-energy X-ray absorptiometry. In this study, data are presented on four regions of the femur (femoral neck, trochanter, inter trochanter and total femur) and total spine (L1–L4). The associations between BMD, SB and PA levels were examined using multiple linear regressions stratified by gender. In addition, the association between the pattern of accumulation of SB (quantified as frequency and duration of SB) and BMD was also investigated. All models were adjusted for known risk factors associated with BMD. In total, data for 2117 individuals, aged 23–90+years (males N=1158), were available to analyse SB and femur BMD and 1942 individuals (males N=1053) for analysis of SB and spine BMD. ResultsThere was no evidence of an association between SB time and hip or spinal BMD in men. For men, time spent doing moderate to vigorous activity (MVPA) and vigorous activity (VIG) was associated with higher total femur and the other hip sub-region BMD. The regression coefficient was BMVPA=0.306 (95% CI: 0.021–0.591)g/cm2 for each 10minute increment in daily MVPA. For VIG, the regression coefficient is BVIG=0.320 (95% CI: 0.058–0.583) but this cannot be interpreted linearly as time spent in vigorous activity was square root transformed. In women, SB was negatively associated with total femur BMD and all sub-regions but not MVPA nor VIG. The regression coefficient for total femur BMD was BSB=−0.159 (95% CI: −0.241–0.076)g/cm2 for each 10minute increment spent being sedentary each day. In addition, the duration of SB bouts was deleteriously associated with BMD for the total femur and of other hip sub-regions, but the number of bouts of SB did not have a significant effect. These associations were found to be independent of the amount of MVPA and VIG that women engage in. No associations were found between SB or PA and spinal BMD for either men or women. ConclusionsThese results provide the first evidence that repeated exposure to sitting (SB), measured objectively in daily life, is deleteriously associated with BMD of the total femur and of all hip sub-regions in women, independent of the amount of time women engage in moderate and vigorous activity. This suggests that SB might be a risk factor for bone health in women independent of whether they engage in physical activity. In addition, the duration of SB bouts, rather than their frequency, appears to be deleteriously associated with BMD of the total femur and of all hip sub-regions. Future research should investigate the effect on bone health of interventions which set out to reduce SB and the duration of SB bouts in comparison, and as adjunct, to the promotion of PA. For men, SB is not significantly associated with BMD of the femur or spine and the results appear to confirm that moderate and vigorous activity has a protective effect.

Racial Disparity in the Associations of Microalbuminuria and Macroalbuminuria with Odds of Hypertension: Results from the NHANES Study in the United States

Background. Limited information is available on whether the associations of microalbuminuria and macroalbuminuria with the odds of hypertension differ among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Methods. Cross-sectional data of 24,949 participants aged ≥18 years were collected from the National Health and Nutrition Examination Survey (NHANES) 1999–2008. Odds ratios of hypertension for microalbuminuria and macroalbuminuria were estimated by conducting weighted multiple logistic regression models. Results. After adjustment for extensive confounding factors, microalbuminuria is 1.45 (95% confidence interval (CI) [1.17, 1.80]), 2.07 (95% CI [1.52, 2.83]) and 2.81 (95% CI [2.06, 3.84]) times more likely to be associated with hypertension, and macroalbuminuria is 4.08 (95% CI [1.98, 8.38]), 8.62 (95% CI [3.84, 19.35]), and 4.43 (95% CI [2.13, 9.21]) times in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, respectively. The odds of hypertension for microalbuminuria (versus normalbuminuria) were 52% higher in non-Hispanic Blacks and 98% higher in Hispanics than in non-Hispanic Whites; the odds of hypertension for macroalbuminuria (versus normalbuminuria) did not differ among racial groups. Conclusion. Racial differences in the relation between microalbuminuria and hypertension are prevalent among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. More screening efforts should be encouraged in normotensive non-Hispanic Blacks and Hispanics with microalbuminuria.

An investigation of the co-variation in circulating levels of a large number of environmental contaminants

We are daily exposed to many different environmental contaminants. Mixtures of these contaminants could act together to induce more pronounced effects than the sum of the individual contaminants. To evaluate the effects of such mixtures, it is of importance to assess the co-variance amongst the contaminants. Thirty-seven environmental contaminants representing different classes were measured in blood samples from 1016 individuals aged 70 years. Hierarchical cluster analysis and principal component analysis were used to assess the co-variation among the contaminants. Within each identified cluster, possible marker contaminants were sought for. We validated our findings using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 study. Two large clusters could be identified, one representing low/medium chlorinated polychlorinated biphenyls (PCBs) (≤6 chlorine atoms), as well as two pesticides and one representing medium/high chlorinated PCBs (≥6 chlorine atoms). PCBs 118 and 153 could be used as markers for the low/medium chlorinated cluster and PCBs 170 and 209 could be used as markers for the medium/high chlorinated cluster. This pattern was similar to data from the NHANES study. Apart from the PCBs, little co-variation was seen among the contaminants. Thus, a large number of chemicals have to be measured to adequately identify mixtures of environmental contaminants.

Insensitivity of the “Romberg Test of Standing Balance on Firm and Compliant Support Surfaces” to the Results of Caloric and VEMP Tests

The objective of this study was to assess the sensitivity, specificity, and positive and negative predictive value of the Romberg Test of Standing Balance on Firm and Compliant Support Surfaces (RTSBFCSS) for the identification of patients with vestibular system impairments affecting the horizontal semicircular canal, saccule, and/or inferior and superior vestibular nerves. The RTSBFCSS was developed for the National Health and Nutrition Examination Survey (NHANES) and was used recently to estimate the numbers of individuals aged 40 yr or older with vestibular system impairments among the general population of the United States. A retrospective analysis of the medical records of 103 consecutive patients aged 40 yr or older (mean age 59 ± 12 yr, 71 females) who had undergone vestibular assessment at the Balance Disorders Clinic at the Vanderbilt University School of Medicine. Patients with complete electro- or videonystagmography testing, cervical vestibular evoked myogenic potential (cVEMP) testing, and the RTSBFCSS screening test were included in the analysis. A series of 2 × 2 tables were created that represented the number of "true positives," "true negatives," "false positives," and "false negatives" of the RTSBFCSS under conditions where the caloric test was abnormal and then separately where the cVEMP test was abnormal. The data were analyzed in a manner such that sensitivity, specificity, and both positive and negative predictive value of the RTSBFCSS could be calculated. When the caloric test was used as the criterion standard and the subject selection criteria in the NHANES study were used (i.e., subjects who were able to maintain postural stability for trials 1-3 of the RTSBFCSS; N = 45), the sensitivity and specificity of the RTSBFCSS to impairment of the horizontal semicircular canal or superior vestibular nerve were 55% and 64%, respectively, yielding positive and negative predictive values of 55% and 64%, respectively. When all patients aged 40 yr or older were evaluated (N = 103), the sensitivity and specificity were 61% and 58%, respectively, yielding positive and negative predictive values of 39% and 78%, respectively. Using the cVEMP test as the criterion standard for the detection of impairment affecting the saccule and/or inferior vestibular nerve did not improve the performance criteria of the NHANES screening measure. The RTSBFCSS should not be used as a screening measure for vestibular impairment.