Nutrition Survey Data Research Articles

Factors affecting hardcore smoking behaviors in Korean adults: Utilizing the Korea National Health and Nutrition Survey Data

Factors affecting hardcore smoking behaviors in Korean adults: Utilizing the Korea National Health and Nutrition Survey Data

Infant and young child feeding practices and nutritional status in Bhutan.

In South Asia, childhood undernutrition persists while overweight is increasing. Internationally recommended infant and young child feeding (IYCF) practices promote healthy nutritional status; however, little is known about IYCF in Bhutan, investigated here using 2015 National Nutrition Survey data. WHO/UNICEF IYCF indicators, anthropometry and household socio-economic status were available for 441 children <24months. Stunting, wasting, and underweight prevalence (<-2Z length-for-age [LAZ], weight-for-age, [WAZ] and weight-for-length [WLZ], respectively) were 15%, 9%, and 5%, respectively, whereas overweight (WLZ >2) prevalence was 6%. In survey-design-adjusted analyses, 52% of mothers of 0- to 5-month olds reported exclusive breastfeeding (EBF), with EBF less common for girls than boys (OR: 0.2 [95% CI: 0.1-0.9]). Although 61% of children were breastfed at 2years and 75% of children >6months met a minimum daily meal frequency, only 18% of children 6-23months met minimum dietary diversity. IYCF was unassociated with risk of stunting, wasting, or underweight, possibly due to relatively low prevalence of anthropometric failure and small sample size. However, currently-breastfed children were less often overweight [OR: ~0.1 (95% upper limit ≤1.0)]. Neither breastfeeding nor most complementary feeding practices differed by socio-economic status, but children in the highest two fifth of a wealth index had 7.8 (1.3-46.9) and 5.3 (1.1-25.2) times greater odds than children in the lowest fifth of meeting minimum dietary diversity criteria. Low rates of EBF, given possible protection of breastfeeding against overweight, and inadequate dietary diversity offer evidence to guide future program interventions to improve nutritional status of young children.

Meeting UK dietary recommendations is associated with higher estimated consumer food costs: an analysis using the National Diet and Nutrition Survey and consumer expenditure data, 2008-2012.

To test whether diets achieving recommendations from the UK's Scientific Advisory Committee on Nutrition (SACN) were associated with higher monetary costs in a nationally representative sample of UK adults. A cross-sectional study linking 4 d diet diaries in the National Diet and Nutrition Survey (NDNS) to contemporaneous food price data from a market research firm. The monetary cost of diets was assessed in relation to whether or not they met eight food- and nutrient-based recommendations from SACN. Regression models adjusted for potential confounding factors. The primary outcome measure was individual dietary cost per day and per 2000 kcal (8368 kJ). UK. Adults (n 2045) sampled between 2008 and 2012 in the NDNS. On an isoenergetic basis, diets that met the recommendations for fruit and vegetables, oily fish, non-milk extrinsic sugars, fat, saturated fat and salt were estimated to be between 3 and 17 % more expensive. Diets meeting the recommendation for red and processed meats were 4 % less expensive, while meeting the recommendation for fibre was cost-neutral. Meeting multiple targets was also associated with higher costs; on average, diets meeting six or more SACN recommendations were estimated to be 29 % more costly than isoenergetic diets that met no recommendations. Food costs may be a population-level barrier limiting the adoption of dietary recommendations in the UK. Future research should focus on identifying systems- and individual-level strategies to enable consumers achieve dietary recommendations without increasing food costs. Such strategies may improve the uptake of healthy eating in the population.

Market Transition, Social Stratification, and Health Disparities in China: Longitudinal Analysis 1991 to 2006

ABSTRACTAlthough a large body of literature has documented that China’s market transition from state socialism led to substantial changes in the social stratification order, little is known about the transition’s implications for health disparities. Integrating the fundamental cause perspective with market transition theory, this article examines the changing association of education and cadre status with self-rated health during the market transition, 1991 through 2006. Analyzing multiple waves of the China Health and Nutrition Survey data (N = 28,227), ordinal logistic mixed effects regression reveals the emerging and increasing role of education in shaping health disparities, while the role of cadre status stayed constant over time. Bringing a health outcome into market transition theory and institutional contexts to fundamental cause theory expands both theories and provides insights into the implication of market transition for health disparities.

Trends in domain-specific physical activity and sedentary behaviors among Chinese school children, 2004\u20132011

BackgroundDramatic increases in child overweight have occurred in China. A comprehensive look at trends in physical activity and sedentary behaviors among Chinese youth is needed. The study aimed to examine trends in domain-specific physical activity and sedentary behaviors, explore mean and distributional changes in predicted behaviors over time, and investigate how behaviors vary by residence.MethodsUsing 2004–2011 China Health and Nutrition Survey data, adjusted means for MET-hours/week from physical activity and hours/week from sedentary behaviors were determined for school children (6–18 years), stratifying by gender, age group, and residence. Physical activity domains included in-school physical activity, active leisure (out-of-school physical activity), active travel (walking or biking), and domestic activity (cooking, cleaning, and child care). For each physical activity domain, the MET-hours/week measure was determined from the total weekly time spent (hours) in domain-specific activities and corresponding MET-values using the Compendium of Energy Expenditures for Youth. Sedentary behaviors included television, computer use, homework, and other behaviors (board games, toys, extracurricular reading and writing). For each sedentary behavior, the hours/week measure was determined from total weekly time spent in specific sedentary behaviors. Residence groups included megacities (population ≥ 20million), cities/towns (300,000 ≤ population < 20million), and rural/suburban areas (population < 300,000). Repeated measure linear mixed and quantile regression models were used to predict adjusted means.ResultsLittle change in physical activity behaviors occurred over time, with the exception of statistically significant trends toward increased domestic activity among male children (p < .05). Across all gender and age groups, statistically significant trends over time toward an average increase in computer use were seen (p < .01); these increases were largely driven by those ≥50th percentile on the distribution. Children living in megacities (versus rural areas) reported higher levels of physical activity, homework, and computer use.ConclusionsIntensified, systematic intervention and policy efforts promoting physical activity and reducing sedentary behaviors among children are needed.

The Changing Pattern of Nutrition Intake by Social Class in Contemporary China, 1991-2011.

To explore the changing pattern of nutrition intake by social class in contemporary China. We defined social class in 2 ways. The first definition was based on employment, and the second definition was based on per capita household income levels. We used China Health and Nutrition Survey data from 1991 to 2011 to show the changes in the relation between social class and nutrition intake. The relation between social class and nutrition intake in China changed significantly within the 2 decades. For example, in the early 1990s, the lowest social class (defined by employment or income) had more caloric intake than did the highest social class; 20 years later, however, the relation reversed, and the lowest social class consumed significantly fewer calories. China has seen a great reversal in its social class-nutrition relationship since the early 1990s. Our study calls for wider recognition that insufficient consumption of food and nutrition is increasingly an issue for people in the lower social classes in China.

Longer sleep is associated with lower BMI and favorable metabolic profiles in UK adults: Findings from the National Diet and Nutrition Survey.

Ever more evidence associates short sleep with increased risk of metabolic diseases such as obesity, which may be related to a predisposition to non-homeostatic eating. Few studies have concurrently determined associations between sleep duration and objective measures of metabolic health as well as sleep duration and diet, however. We therefore analyzed associations between sleep duration, diet and metabolic health markers in UK adults, assessing associations between sleep duration and 1) adiposity, 2) selected metabolic health markers and 3) diet, using National Diet and Nutrition Survey data. Adults (n = 1,615, age 19–65 years, 57.1% female) completed questions about sleep duration and 3 to 4 days of food diaries. Blood pressure and waist circumference were recorded. Fasting blood lipids, glucose, glycated haemoglobin (HbA1c), thyroid hormones, and high-sensitivity C-reactive protein (CRP) were measured in a subset of participants. We used regression analyses to explore associations between sleep duration and outcomes. After adjustment for age, ethnicity, sex, smoking, and socioeconomic status, sleep duration was negatively associated with body mass index (-0.46 kg/m2 per hour, 95% CI -0.69 to -0.24 kg/m2, p < 0.001) and waist circumference (-0.9 cm per hour, 95% CI -1.5 to -0.3cm, p = 0.004), and positively associated with high-density lipoprotein cholesterol (0.03 mmol/L per hour, 95% CI 0.00 to 0.05, p = 0.03). Sleep duration tended to be positively associated with free thyroxine levels and negatively associated with HbA1c and CRP (p = 0.09 to 0.10). Contrary to our hypothesis, sleep duration was not associated with any dietary measures (p ≥ 0.14). Together, our findings show that short-sleeping UK adults are more likely to have obesity, a disease with many comorbidities.

Contribution of weight status to asthma prevalence racial disparities, 2–19 year olds, 1988–2014

PurposeRacial disparities in childhood asthma prevalence increased after the 1990s. Obesity, which also varies by race/ethnicity, is an asthma risk factor but its contribution to asthma prevalence disparities is unknown. MethodsWe analyzed nationally representative National Health Examination and Nutrition Survey data for 2–19 year olds with logistic regression and decomposition analyses to assess the contributions of weight status to racial disparities in asthma prevalence, controlling for sex, age, and income status. ResultsFrom 1988–1994 to 2011–2014, asthma prevalence increased more among non-Hispanic black (NHB) (8.4% to 18.0%) than non-Hispanic white (NHW) youth (7.2% to 10.3%). Logistic regression showed that obesity was an asthma risk factor for all groups but that a three-way “weight status-race/ethnicity-time” interaction was not significant. That is, weight status did not modify the race/ethnicity association with asthma over time. In decomposition analyses, weight status had a small contribution to NHB/NHW asthma prevalence disparities but most of the disparity remained unexplained by weight status or other asthma risk factors (sex, age and income status). ConclusionsNHB youth had a greater asthma prevalence increase from 1988–1994 to 2011–2014 than NHW youth. Most of the racial disparity in asthma prevalence remained unexplained after considering weight status and other characteristics.

Poor early childhood outcomes attributable to maternal depression in Mexican women.

We aimed to estimate the population fraction of poor early child health and developmental outcomes attributable to maternal depressive symptoms (DS) contrasting it between low- and middle/high-income households. We used a nationally representative probabilistic sample of 4240 children younger than 5years old and their mothers, derived from the Mexican National Health and Nutrition Survey Data (ENSANUT 2012). Complex survey design, sampling, and analytic weights were taken into account in analyses. DS was measured by CESD-7. Child outcomes were as follows: breastfeeding, attending well-child check-ups, respiratory disease, diarrhea and general health problems, immunization, accidents, growth, obesity, and food insecurity. Prevalence of DS among mothers was 21.36%. In low-SES households, DS was associated with higher risk of never being breastfed (RR=1.77; p<.05), health problems (RR=1.37; p<.05), acute respiratory disease (RR=1.51; p<.05), accidents requiring child hospitalization (RR=2.16; p<.01), and moderate or severe food insecurity (RR=1.58; p<.001). In medium- or high-SES households, DS was associated with higher risk of never attending a developmental check-up (RR=2.14; p<.05) and moderate or severe food insecurity (RR=1.75; p<.01). Population risks attributable to DS ranged from 2.30 to 17.45%. Prevention of DS could lead to reduction of problematic early childhood outcomes in both low and medium/high SES.

Assessment of the effectiveness of a small quantity lipid-based nutrient supplement on reducing anaemia and stunting in refugee populations in the Horn of Africa: Secondary data analysis.

Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and its partner organisations implement blanket supplementary feeding programmes using a range of special nutritional products as one approach to address these issues. The evidence base for the efficacy and effectiveness of a small quantity lipid-based nutrient supplement, Nutributter®, in reducing stunting and anaemia is limited. Secondary data analysis was used to assess the effectiveness of Nutributter® distribution on anaemia and stunting in children aged 6–23 months (programme target group) and 6–59 months (the standard age group sampled in routine nutrition surveys). Analysis was conducted using routine pre and post-intervention cross-sectional nutrition survey data collected between 2008–2011 in five refugee camps in Kenya and Djibouti. Changes in total anaemia (Haemoglobin<110g/L), anaemia categories (mild, moderate and severe), and stunting (height-for-age z-score <-2) were explored using available data on the Nutributter® programme and contextual factors. A significant reduction in the prevalence of anaemia in children aged 6–23 months and 6–59 months was seen in four of five, and in all five camps, respectively (p<0.05). Reductions ranged from 12.4 to 23.0, and 18.3 to 29.3 percentage points in each age group. Improvements were largely due to reductions in moderate and severe anaemia and occurred where the prevalence of acute malnutrition was stable or increasing. No change in stunting was observed in four of five camps. The replicability of findings across five sites strongly suggests that Nutributter® distribution was associated with a reduction in anaemia, but not stunting, among refugee children in the Horn of Africa. Benefits were not restricted to the 6–23 month target group targeted by the nutrition programme. However, even following this intervention anaemia remained a serious public health problem and additional work to define and evaluate an effective intervention package is warranted.

Dietary patterns, dietary lead exposure and hypertension in the older Chinese population.

With rapid population ageing and an increasing rate of hypertension in China, this study aims to examine the association between dietary patterns, dietary lead and hypertension among older Chinese population. We analysed the 2009 China Health and Nutrition Survey data (2,634 individuals with dietary and hypertension measurement data, aged ≥60 years). Dietary data were obtained using 24 hour-recall over three consecutive days. Dietary lead intake is based on a published systematic review of food lead concentration and dietary lead exposure in China. Factor analysis was used to identify dietary patterns. Poisson regression and multinomial logistic regression models were used to explore the association between dietary patterns and hypertension. The prevalence of hypertension was 47.0% in men and 48.9% in women. Traditional dietary pattern (high intake of rice, pork and vegetables) was significantly inversely associated with known hypertension. In the fully adjusted model, compared with the lowest quartile of traditional dietary pattern, the highest quartile had a lower risk of known hypertension, with Relative Risk Ratio=0.69 (95% CI: 0.50; 0.95). However, associations between modern dietary pattern and hypertension differed by urbanization; an inverse, positive and null association was seen in low, medium and high urbanization. Additionally, dietary lead showed a significant positive association with hypertension and known hypertension. Policies that facilitate and promote healthy diets, and the availability of healthy foods particularly at the regional and local levels, are important for the prevention of hypertension.

Protein Delivery in the Intensive Care Unit: Optimal or Suboptimal?

Emerging evidence suggests that exogenous protein/amino acid supplementation has the potential to improve the recovery of critically ill patients. After a careful review of the published evidence, experts have concluded that critically ill patients should receive up to 2.0-2.5 g/kg/d of protein. Despite this, however, recent review of current International Nutrition Survey data suggests that protein in critically ill patients is underprescribed and grossly underdelivered. Furthermore, the survey suggests that most of protein administration comes from enteral nutrition (EN) despite the availability of products and protocols that enhance the delivery of protein/amino acids in the intensive care unit (ICU) setting. While future research clarifies the dose, timing, and composition for exogenous protein administration, as well as identification of patients who will benefit the most, ongoing process improvement initiatives should target a concerted effort to increase protein intake in the critically ill. This assertion follows from the notion that current patients are possibly being harmed while we wait for confirmatory evidence. Further research should also develop better tools to enable bedside practitioners to monitor optimal or adequate protein intake for individual patients. Finally, exploring the effect of combining adequate protein delivery with early mobility and/or resistance exercise in the ICU setting has the greatest potential for improving the functional outcomes of survivors of critical illness and warrants further study.

Consideration in Analysis of Nutrition Survey Data from Korea National Health and Nutrition Examination Survey

Consideration in Analysis of Nutrition Survey Data from Korea National Health and Nutrition Examination Survey

Determinants of HPV vaccine awareness and healthcare providers' discussion of HPV vaccine among females.

Two human papillomavirus (HPV) vaccines are available and can prevent 98% of HPV 16 and 18 infections. This study aimed to explore determinants of 1) HPV vaccine awareness among a cohort of low-income women participating in a cancer prevention program in Central Texas and compare them to United States residents; 2) determinants of healthcare providers' discussion of HPV vaccine among female residents of the United States.Bivariate and multivariable analysis of HPV vaccine awareness using survey data (n = 359) collected between 2014 and 2016 in Central Texas, and the Health Information and Nutrition Survey (HINTS) data which is a nationally representative dataset (unweighted n = 1214) collected in 2013 were conducted. Bivariate and multivariable regression analyses of healthcare providers' discussion of the HPV vaccine using the HINTS survey data were also conducted.Compared to non-Hispanic Whites, there was a decreased likelihood of HPV vaccine awareness among non-Hispanic Blacks (OR = 0.50; 95% CI = 0.28–0.90) and Hispanics (OR = 0.55; 95% CI = 0.30–0.99) in the grant funded program, as well as non-Hispanic Blacks (OR = 0.28; 95% CI = 0.14–0.58) and Hispanics (OR = 0.22; 95% CI = 0.12–0.41) in the HINTS data. There was also a decreased likelihood of healthcare providers discussing the HPV vaccine with respondents who were 35–49 years (OR = 0.50; 95% CI = 0.30–0.84), 50–64 years (OR = 0.26; 95% CI = 0.14–0.49) or ≥ 65 years compared to those who were 18–34 years among the HINTS data respondents.Interventions to increase HPV awareness among non-Hispanic Blacks and Hispanics, as well as encourage healthcare providers' discussion of the HPV vaccination during patient encounters regardless of the patient's age are needed.

The Long-Term Impact of Household Wealth on Income Mobility

By using the China Health and Nutrition Survey data, this paper targets the generation who enter the labor market at the age of 18 to 35 and tries to study the long-term impact of their family health on income mobility as well as keep track of the tendency. Three conclusions can be drown from the research. Firstly, the impact is more significant in the second poor group and the middle-income group than that in the high-income group, and that of the low-income group is the worst. Secondly, in the long run, the impact shows a weakening trend, but the changing process is not the same. Thirdly, the significance of impact varies in different age groups. Compared with the groups aged 20 to 35 and 25 to 30, the impact is relatively remarkable for those who just enter the labor market aged 18 to 25.

A Research on the Difference of Education Returns between Urban and Rural Areas

In this paper, the China Health and Nutrition Survey data are used to analyze the return rates of different educational stages in urban and rural areas in 2004 and 2006 respectively. The results show that the rate of return on primary and secondary education of urban laborers is significantly low, while higher education returns were significantly high, which means that the city labor force should accept more higher education. The rate of return on primary education for rural laborers has been significantly reduced, and the rate of return on secondary education has increased significantly, which means that rural labor force should receive more secondary education. Within the secondary education, the rate of return on vocational and technical education is higher than that of ordinary high school education in both the rural laborers and the urban laborers, so the government should guide the development of secondary vocational and technical schools and increase investment in secondary vocational education.

Increasing dietary protein intake in community dwelling older adults: protocol for a randomised controlled trial and baseline data

Dietary protein has an important impact on health, physical functioning, and muscle mass, and it has been suggested that older adults need more dietary protein than younger adults(1) . Compared to other protein rich foods, eggs are easy to cook, of long shelf life, and low cost; so they may be of help in increasing protein intake in older adults. Reasons for eating or not eating eggs in adults aged 55 years and older were identified in a focus group study(2) and then used to design a structured questionnaire which was sent out to a National sample(3) . Our questionnaire results showed that older adults who eat more eggs report that they think eggs taste good and add variety to the diet. Adding flavour and more variety may encourage intakes in those who consume fewer eggs. A randomized controlled intervention study was designed to increase egg and protein intake, by providing recipes of protein-rich egg-based meals and herbs/spice packets, to encourage the addition of flavour and variety to the diet. Community dwelling adults aged 55 years and over were randomized to receive dietary information followed by either 6 recipes and relevant herbs/spices every fortnight for 3 months, or northing further. Dietary intake (Food Frequency Questionnaire(4) ), body composition (Bioelectrical Impedance Analysis), handgrip strength, and physical performance (Short Physical Performance Battery (SPPB)(5) ) were assessed at baseline, and will be assessed again after the 3-month intervention period and at a 6-month follow up. The study is registered at ClinicalTrials.gov (NCT02777918). All participants have so far completed baseline sessions. A total of 100 participants are taking part - 54 females and 46 males; mean age at baseline was 70 ± 7 years, range 55–97 years. Egg intake was 22 ± 16 eggs per month, which is higher than the National Diet and Nutrition Survey data indicating that British older adults (65yrs+) consume 33 g of eggs and egg dishes per month (equivalent to up to 16–17 eggs). Reported protein intake was 1·24 ± 0·42 g/kg/day. In this sample, 10 % did not meet the Reference Nutrient Intake for all adults of 0·75 g/kg/day, and 50 % did not meet the 1·2 g/kg/day which has been suggested as the protein requirement for older adults(1) . Mean BMI was 27 ± 4 kg/m2 ; lean mass (LM) percentage was 61 ± 6 % for females, and 74 ± 5 % for males; handgrip strength was 25 ± 4 kg for females, and 40 ± 9 kg for males; and SPPB score (0–12) was 9 ± 2. In our sample, 11 % of the females and 9 % of the males could be classified as sarcopenic based on handgrip strength(6) , which is within the estimated range of sarcopenia in community dwelling populations (1–29 % prevalence)(7) . Providing recipes could be a straightforward to implement strategy to encourage older adults to consume more eggs and more protein, which could support good health.

Participation in a Quality Improvement Collaborative and Change in Maternity Care Practices.

Care immediately following birth affects breastfeeding outcomes. This analysis compared improvement in maternity care practices from 2011 to 2013 among hospitals participating in a quality improvement collaborative, Best Fed Beginnings (BFB), to hospitals that applied but were not selected (non-Best Fed Beginnings [non-BFB]), and other hospitals, using Centers of Disease Control and Prevention's Maternity Practices in Infant Nutrition and Care (mPINC) survey data to calculate total and subscores for 7 care domains. Analysis of covariance compared change in scores from 2011 to 2013 among BFB, non-BFB, and other hospitals. BFB hospitals had twice the increase in mPINC score compared to non-BFB and a 3-fold increase compared to other hospitals. Learning collaborative participation may have accelerated progress in hospitals implementing breastfeeding-supportive maternity care.

Sociodemographic disparity in the diet quality transition among Chinese adults from 1991 to 2011.

This study investigates secular trends in diet quality distribution and related socioeconomic disparity from 1991 to 2011 in the Chinese adult population. The analysis uses the 1991-2011 China Health and Nutrition Survey data on 13 853 participants (6876 men and 6977 women) aged 18-65 with 56 319 responses. Dietary assessment was carried out over a 3-day period with 24-h recalls combined with a household food inventory. We tailored Alternative Healthy Eating Index 2010 (named as tAHEI) to measure diet quality and performed quantile regression to investigate shifts in tAHEI scores at different percentiles and used mixed-effect linear regression to examine average diet quality trend and potential sociodemographic disparity. The energy-adjusted mean tAHEI scores increased from 36.9 (36.7-37.1) points in 1991 to 50.3 (50.1-50.5) in 2011 for men (P<0.001) and from 35.6 (35.4-35.8) to 46.9 (46.7-47.1) for women (P<0.001). The covariate-adjusted score of polyunsaturated fatty acids increased by 6.8 (6.6, 7.0) and 7.0 (6.9, 7.2), and the score of long-chain (ω-3) fats increased by 5.3 (5.2, 5.4) and 5.3 (5.2, 5.5) in men and women, respectively, whereas the cereal fiber and red meat scores decreased slightly. Increasing tAHEI score occurred across the entire distribution, and diet quality transition varied across sociodemographic groups. Chinese diet quality is far from optimal, with moderate improvement over a 21-year period. Findings suggest that nutritional intervention should give priority to low-income, low-urbanized communities and southern provincial adults with low diet quality in China.

Boys, Girls, and Grandparents: The Impact of the Sex of Preschool-Aged Children on Family Living Arrangements and Maternal Labor Supply

This paper considers how the sex of preschool-aged children can affect living arrangements and maternal labor supply. In an extended family with young children, the joint decisions of co-residence and time allocations are driven by the concern that the companionship of children is a household public good and that family members share childcare and related domestic duties. The incentive to share children’s companionship is affected by son preference, whereas the economic motive for labor division hinges on the potential wage rate of the mother. The preference for sons drives the decisions in households with mothers whose wage rates are low, whereas both channels determine the decisions in households with mothers whose wage rates are high. Using China Health and Nutrition Survey (CHNS) data, we find that among less-educated mothers, the incidence of a family co-residing with the paternal grandmother is at least 8.6 percentage points higher if the firstborn is a boy. At the same time, maternal labor supply increases by 2.892 days per month. By contrast, for educated mothers, the propensity for co-residence is higher, and the working hours are longer than for less-educated mothers, and the impact of the child’s sex is not significant. This paper not only provides a better understanding of the demographic and economic factors determining co-residence and intra-household time allocations, but also lends empirical support to policies aiming to increase female labor supply and improve the well-being of girls.