Poverty Income Ratio Research Articles

Fiber Intake Varies by Poverty-Income Ratio and Race/Ethnicity in the US Adults

Fiber has been identified as both a ‘shortfall nutrient’ and a ‘nutrient of public health concern.’ However, little is known about dietary fiber intake relative to poverty-income ratio (PIR) and race/ethnicity in US adults. We examined usual intakes of dietary fiber and compliance with the adequate intake (AI) in US adults (≥19 years) using National Health and Nutrition Examination Survey 2011 to 2012 by PIR and race/ethnicity. Among both men and women, significantly higher fiber intake was observed among those in the highest PIR category (men, 22 [SE, 0.8]; women, 18 [SE, 0.6]) compared with those in the lowest category (men, 20 [SE, 0.7]; women, 15 [SE, 0.4]) and the middle category (men, 19 [SE, 0.7]; women, 15 [SE, 0.6]). Although men had higher intake of fiber across all PIR and race/ethnic groups, women had higher prevalence of intake above the AI. Among men, non-Hispanic blacks (17 [SE, 0.8]) had significantly lower intake; whereas among women non-Hispanic blacks (14 [SE, 0.4]) and Hispanic and Mexican Americans (16 [SE. 0.8]) had significantly lower intake compared with the other race/ethnic groups. Asian American women have the highest likelihood of fiber intake that exceeds the AI recommendation. Overall, fiber intake of US adults remains below federal recommendations. Systematic differences in fiber intake occur by PIR and race. Therefore, it is particularly salient to target intervention and education efforts to increase intake of dietary fiber in these groups.

Relationship between Selected Serum Metallic Elements and Obesity in Children and Adolescent in the U.S.

The prevalence of obesity has increased at an alarming rate worldwide. Metallic elements are involved in the pathogenesis of obesity and related diseases. To date, whether environmental exposure to metallic elements has effects on obesity in children and adolescents is still unclear. The aim of the current study was to investigate the association of blood metallic elements with obesity in U.S. children and adolescents. This cross-sectional study was performed with 5404 children and adolescents (6–19 years, 2745 males and 2659 females) who participated in the US National Health and Nutrition Examination Survey 2011–2014. Blood lead, mercury, selenium, manganese, copper, and zinc, as well as biochemical parameters including triglyceride (TG), cholesterol, low-density lipoprotein (LDL), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed for all subjects. Multivariate logistic regression and linear regression were applied to assess associations of metallic elements and overweight, obesity status, and serum metabolites as distinct outcomes adjusted for age, gender, ethnicity, and the poverty income ratio. When stratified by age and sex, significant associations were found between the highest quartile of copper concentrations in blood with obesity status (OR = 9.27, 95% CI: 5.43, 15.82, pfor trend < 0.001) and cholesterol (OR = 3.08, 95% CI: 1.43, 6.63, pfor trend < 0.001). The highest concentrations of manganese in the blood was associated with obesity in those aged 6–19 years (OR = 2.29, 95% CI: 1.74, 3.02, pfor trend < 0.001). Moreover, blood mercury and selenium showed positive relationships with cholesterol. Further, a negative association existed between blood zinc and obesity. The National Health and Nutrition Examination Survey data provide epidemiological evidence that blood metallic elements are positively associated with obesity in children and adolescents. However, the underlying mechanisms still need further exploration.

Breastfeeding for One Month or Longer is Associated with Higher Risk of Osteoarthritis in Older Adults: NHANES 1999-2012.

Breastfeeding is associated with many health benefits to the mother but the association between osteoarthritis (OA) is not known. Menopause, a state of rapid estrogen loss, is associated with OA. To test whether lactation, another physiological state of low estrogen status, is associated with OA, a nationally representative dataset National Health and Nutrition Examination Survey (NHANES) 1999–2012 was analyzed. Information of OA diagnosis history and lactation for at least one month was self-reported by women 50 years and older that had given birth to at least one child. Women that breastfed for less than one month had a higher proportion of those that were 60 years and older, Hispanic (than non-Hispanic Black), and higher current/self-reported greatest body mass index. Women that breastfed for one month or longer had a higher proportion of those that had 3 or more children, higher poverty-income ratio, were post-menopausal and performed vigorous physical activity. Weighted percentage of OA patients was 22%, and did not differ between the two groups. However, when logistic regression was performed adjusting for multiple covariates, lactation for one month or longer was positively associated with OA. Women that breastfed for one month or longer had an adjusted odds ratio of 1.21 (95% confidence interval, 1.05–1.40) for OA compared to those that breastfed for less than one month. The results indicate that women that breastfed for at least one month have a higher risk of OA than women that delivered a child but breastfed for less than one month.

An Examination of the Sociodemographic and Health Determinants of Major Depressive Disorder Among Black Women.

Black women disproportionately share the distribution of risk factors for physical and mental illnesses. The goal of this study was to examine the sociodemographic and health correlates of major depressive disorder (MDD) symptoms among black women. Pooled data from the 2005-2010 National Health and Nutrition Examination Survey (NHANES) were used to assess the sociodemographic and health correlates of MDD symptoms among black women (n=227). Multivariate logistic regression techniques assessed the association between MDD symptoms and age, socioeconomic status, health status, and health behaviors. Poverty income ratio and smoking status were significantly associated with the likelihood of having MDD symptoms. Black women who were smokers were also more likely to have MDD symptoms compared to non-smokers [OR=8.05, 95% CI=(4.56, 14.23)]. After controlling for all other socioeconomic and health variables, this association remained statistically significant. In addition, after controlling for all other variables, the multivariate analyses showed that black women below 299% federal poverty level (FPL) were nearly three times more likely to have MDD symptoms compared to women above 300% FPL [OR=2.82, 95% CI=(1.02, 7.96)]. These analyses suggest that poverty and smoking status are associated with MDD symptoms among black women. A deeper understanding of the underlying mechanisms and key factors which influence MDD symptoms are needed in order to develop and create mental health programs targeting women of color.

Body burden of heavy metals among HIV high risk population in USA

ObjectiveHIV high risk population may face not only the threat of HIV infection but also a higher chance of exposure to environmental contaminants. However, no previous studies have examined the body burden of environmental pollutants including heavy metals among HIV high risk populations. The aim of this study was to investigate whether adults aged 20–59 years old at high risk of HIV infection have higher blood levels of heavy metals compared to those with low risk of HIV infection in United States. Material and methodsWe used the National Health and Nutrition Examination Survey (NHANES) 1999–2010 to compare exposures to heavy metals including cadmium, lead, and total mercury by HIV risk status. ResultsThe results showed that people at high risk of HIV had higher blood concentrations of all heavy metals compared to their counterparts with lower HIV risks. In multivariate linear regression models, HIV risk status was significantly associated with increased blood cadmium, lead, and total mercury after adjusting for age, sex, race, education, and poverty income ratio. ConclusionsOur study suggests that people at high risk of HIV have significantly higher body burden of heavy metals including cadmium, lead, and mercury compared to those with low risk of HIV. Further longitudinal study collecting more pollutants are warranted to determine the potential health effects of these elevated pollutants on both HIV-infected and HIV high-risk populations.

Association between thyroid function and urinary levels of 3,5,6-trichloro-2-pyridinol: data from NHANES 2007-2008.

Data from National Health and Nutrition Examination Survey for the years 2007-2008 were used to evaluate the association between serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), total thyroxine (TT4), and thyroglobulin (TGN) with the urinary levels of 3,5,6-trichloro-2-pyridinol (TCPY). Gender-stratified regression models with log10-transformed values of thyroid hormones as dependent variables and TCPY tertiles, age, race/ethnicity, smoking and iodine sufficiency statuses, fasting time, body mass index, and poverty income ratio as independent variables were fitted. TCPY levels were not found to be associated with the levels of TSH, FT3, FT4, and TT3 for either males or females. TCPY levels in the third tertile as compared to first tertile were found to be negatively associated (p≤0.01) with TT4 levels for both males and females. TGN levels for those males who were in third tertile of TCPY were statistically significantly lower (p<0.01) than for those who had their TCPY levels in first or second tertile. Irrespective of age, gender, race/ethnicity, and smoking status, unadjusted TCPY levels for the period 2009-2010 were statistically significantly lower (p<0.01) than TCPY levels during the period 2001-2002. TCPY levels for 2009-2010 were as low as 35.8% of what they were in 2001-2002 for adolescents and not more than 56.9% of what they were for 2001-2002 for males.

Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey.

BackgroundCardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon.Methods and ResultsHypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010–2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10–1.29), diabetic (OR, 1.43; 95% CI, 1.17–1.73), and hypertensive (OR, 1.18; 95% CI, 1.05–1.32) than those residing in the United States for <10 years.ConclusionsIn an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.

Association of Secondhand Smoke With Stroke Outcomes.

Approximately half of never smokers are exposed to secondhand smoke (SHS). Smoking is a well-established stroke risk factor, yet associations between SHS, stroke, and poststroke mortality remain uncertain. We aimed to determine the prevalence of exposure to SHS among those with and without stroke and its impact on mortality. Data were obtained from the US National Health and Nutrition Examination Surveys for 27 836 never smokers with/without self-reported stroke aged ≥18 years, sampled from 1988 to 1994 and 1999 to 2012, with linked mortality through 2010. Household exposure to SHS was determined by self-report; exposure severity was quantified by serum cotinine level. Independent relationships between SHS and all-cause mortality were assessed using Cox regression models, before and after adjusting for sociodemographics and comorbidities. From 1988 to 1994 to 1999 to 2012, age-adjusted prevalence of exposure to SHS declined from 11.5% to 6.6% among survivors of stroke (P=0.08), and 14.6% to 5.9% among persons without stroke (P<0.01). Factors associated with high exposure to SHS were male sex, black race, ≤12th-grade education, poverty income ratio ≤200%, high alcohol intake, and history of myocardial infarction (all P<0.05). High exposure to SHS was associated with higher odds of previous stroke (odds ratio, 1.46; P=0.026). There was a dose-dependent relationship between exposure to SHS and all-cause mortality after stroke. Individuals with previous stroke have 50% greater odds to have been exposed to SHS; SHS is associated with a 2-fold increase in mortality after stroke. This study highlights the importance of obtaining exposure to SHS history and counseling patients and their families on the potential impact of SHS on poststroke outcomes.

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.

Parabens and Asthma Morbidity Among Children 6-19 Years of Age with Asthma: NHANES (2005-2010).

Introduction: Parabens, phenols with antimicrobial properties, are used as preservatives in personal care products. Human exposure is ubiquitous and limited studies suggest that they play a role in allergic disease and asthma. Little is known about their effect on asthma morbidity among asthmatics. We examined the cross-sectional association between exposure to parabens and self-reported asthma-related outcomes among asthmatic children (6-19 years) from a nationally-representative U.S. sample. Methods: We conducted multivariate logistic regression to assess the association between urine concentrations of four parabens (butyl (BP), ethyl (EP), propyl (PP), and methyl paraben (MP)) and asthma attack, emergency department visit, nocturnal wheeze, and missed school due to wheezing over the last year in 261 asthmatic children from the National Health and Nutrition Examination Survey (2005-2010). We adjusted models a priori for age, gender, race, poverty income ratio, and creatinine levels. Results: EP, BP, PP, and MP were respectively detected in the urine of 38%, 42%, 96%, and 99% of children. Relative to children with non-detectable BP levels, children with detectable BP levels had a higher odds of having an asthma attack (adjusted odds ratio (aOR): 3.29, 95% Confidence Interval (CI): 1.34, 8.05). Relative to children in the lowest tertile of PP exposure, children in the upper tertiles had a higher odds of having an asthma attack (tertile 2 (T2) aOR: 2.19, 95% CI: 1.00, 4.77; tertile 3(T3) aOR: 1.17, 95% CI: 0.41,3.34; ptrend&gt;0.05). Relative to children in the lowest tertile of MP exposure, children in the upper tertiles had a higher odds of having missed school due to wheezing (T2 aOR: 1.27, 95% CI: 0.62, 2.61; T3 aOR: 2.46, 95% CI: 1.15, 5.25; ptrend=0.02). No other significant associations were observed. Conclusions: Findings support the need for additional studies aimed at understanding if there is a causal relationship between paraben exposure and asthma morbidity.

Insulin resistance modifies the association between obesity and current asthma in adults.

Insulin resistance potentiates the association between obesity and childhood asthma, but this relationship appears inconsistent in relatively small studies of adults. We investigated effect modification in adults using the National Health and Nutrition Examination Survey 2003-2012, a large, nationally representative database.Insulin resistance and a history of physician-diagnosed current asthma were obtained from 12 421 adults, ages 18-85 years. We used logistic regression to determine associations between obesity and current asthma, adjusting for age, sex, race/ethnicity, poverty income ratio and smoking status. An interaction term evaluated effect modification by insulin resistance of the obesity-asthma association.As expected, obesity was positively associated with current asthma. Insulin resistance modified this association, with obesity measured as body mass index, waist circumference or waist-to-height ratio. The relationship between obesity and current asthma was stronger with increasing insulin resistance tertiles (OR 2.05, 95% CI 2.76-3.00; p-value for interaction 0.03). This association was robust to adjustments for other components of the metabolic syndrome (hypertriglyceridaemia, hypertension, hyperglycaemia and systemic inflammation). None of these components were themselves effect modifiers of the obesity-asthma association.In this large, nationally representative sample, insulin resistance modified the association between obesity and current asthma in adults. Targeting insulin resistance may represent a novel therapeutic strategy for obese patients with asthma.

Association of Single Serving Frozen Meals with Energy Intakes at Meals and for the Entire Day in U.S. Adults: NHANES 2001–2012

The efficacy of portion‐controlled single serving meals for weight reduction has been demonstrated repeatedly. Most studies have focused on meals specifically designed for weight reduction, which consumers might identify as “diet meals.” We hypothesize that the energy reduction benefit of single serving meals extends beyond meals targeting weight loss to include most single serving frozen meals (SSFM) consumed by U.S. adults. To explore this hypothesis, the association of SSFM consumption with energy intake was examined in adults (19+ yrs; n=29,684) using the National Health and Nutrition Examination Survey, 2001–2012. SSFM consumers were defined as those consuming any SSFM (n=409) during the first dietary recall. Additionally, a subgroup (SSFM75) was defined as those consuming SSFM at &lt;75th percentile for calories, &lt;443 kcal (n=294). This subgroup represents SSFM that would be most useful for energy reduction through meal replacement by excluding those meals specifically developed for those with hearty appetites seeking large portion size. Non‐consumers were defined as those not consuming any SSFM, and a subset of non‐consumers were defined as those who consumed dinner at home (DAH), to reduce confounding by restaurant meals. Regression analyses were performed and adjusted means ± standard errors were determined with covariates: age, gender, ethnicity, poverty income ratio, physical activity level, smoking status, and alcohol intake using sample weights and assigning P&lt;0.05 as significant. SSFM consumers and the SSFM75 subgroup were more likely to be older, female, non‐Hispanic White, and less likely to be Mexican American. Dinner was the most popular meal time occasion for SSFM consumption (about 60% intake). SSFM consumers consumed similar daily calories (−41 kcal/d, P=0.3471) and the SSFM75 consumed 161 kcal/d less (P=0.0013) than non‐consumers. When compared to non‐consumers‐DAH, these relationships remained (SSFM consumers −42 kcal, P=0.3410 and SSFM75 −162 kcal, P=0.0014). When meal occasions were examined, the lunch meal energy intake of SSFM consumers showed no difference (−17 kcal, P=0.5614), but lunch energy was significantly lower for SSFM75 (−105 kcal, P=0.0028) compared to non‐consumers. Moreover, dinner energy for both SSFM and SSFM75 consumers was lower than that of non‐consumers (−102 kcal, P=0.0011 and −198 kcal, P&lt;0.0001, respectively). The results suggest that SSFM, especially those that contain less than 450 calories, are associated with reduced daily energy intake. The impact of SSFM may be greatest when replacing the dinner meal. Commercially available SSFM offer an underutilized resource to help consumers lower their energy intake to achieve and maintain healthy weight.Support or Funding InformationSupport provided by ConAgra Foods.

Ready‐To‐Eat Cereal Consumption is Associated with Improved Nutrient Intakes and Nutrient Adequacy in Lower Income Children and Teens: Results from NHANES 2007–2012

This study examined food and nutrient intakes and nutrient adequacy in children (4–12 yr, n=2818) and teens (13–18 yr, n=1343) living in households qualifying for government nutrition assistance programs (Poverty Income Ratio &lt;185%) by ready‐to‐eat cereal consumption pattern (RTEC). Among participants, 45.8% of children and 29.6% of teens were classified as RTEC eaters based on day‐1 dietary intakes from NHANES 2007–2012. USDA Food Patterns Equivalents Database was used to assess consumption of dairy and whole grain (WG). Across all ages, RTEC eaters had significantly (p&lt;0.05) higher intakes of key micronutrients, including calcium, vitamin D, and iron (p&lt;0.0001), but similar intakes of total calories compared to non‐RTEC eaters. Total sugar intake was similar between groups for children only. RTEC contributed a substantial percentage of daily micronutrients in children and teens: vitamin D (18, 21%), folate (50, 53%), iron (45, 50%) and vitamin A (31, 38%). RTEC was the largest contributor to WG intake in children (54%) and teens (59%), and RTEC consumption was associated with significantly higher intakes of WG and dairy compared to non‐RTEC eaters (p&lt;0.05). In both age groups, a higher percentage of non‐RTEC eaters did not meet daily Estimated Average Requirements for zinc, vitamin A, vitamin C, calcium and vitamin D compared to RTEC‐eaters. These findings support the role of RTEC as a nutrient dense food and a significant source of key nutrients and WG in the diets of American children from lower income households.Support or Funding InformationFunded by the Bell Institute of Health and Nutrition, General Mills, Inc.

Association of Consumption of Different Pasta Food Categories with Diet Quality and Select Nutrient Intakes in Adults (19+ years) from NHANES, 2009–2012

Pasta represents a complex group of foods almost ubiquitously consumed in the American diet in both healthy and less healthy ways. The purpose of this analysis was to examine pasta consumption relative to overall diet quality [as measured by the Healthy Eating Index‐2010 (HEI)] as well as nutrients of public health concern (dietary fiber, calcium, potassium, and vitamin D) among adults using data from National Health and Nutrition Examination Survey (NHANES), 2009–2012 (n=10,697). USDA food categories were utilized to separate pasta consumers from non‐consumers from dietary data reported through a 24‐hour dietary recall: (a) 4004: Pasta, noodles and cooked grains (excluding non‐pasta grains) (PN); b) 3204: Pasta mixed dishes, excludes macaroni and cheese (PMD); and c) 3206: Macaroni and cheese (MC). Regression models employed the survey design features and sampling weights and were adjusted for relevant covariates (i.e., age, gender, race/ethnicity, poverty income ratio, physical activity level, current smoking status, alcohol, and energy intake, when appropriate); significance was set at p&lt;0.05. When pasta consumers as a group were compared to non‐consumers, no differences in overall diet quality were observed (HEI mean ± SE: 50.0 ± 0.6 v 51.0 ± 0.3, p=0.09); however among females, pasta consumers had significantly lower HEI scores (50.3 ± 0.9 v 52.4 ± 0.3. p=0.01). When the pasta groups were examined separately, consumers of PN had a higher total HEI score (53.6 ± 1.4 v 50.7 ± 0.3, p=0.0385) than non‐consumers; no gender differences were observed. When genders were combined, no overall differences in HEI were observed by PMD, but a small but significant reduction in females was observed (50.0 ± 0.9 v 52.3 ± 0.3, p=0.02). Consumers of MC had a significantly lower HEI (46.9 ± 1.0 v 51.0 ± 0.3, p=0.0003) driven primarily by differences in females (47.9 ± 0.3 v 52.3 ± 0.4, p=0.001). Dietary fiber was higher among all pasta consumers than non‐consumers, (19.2 ± 0.3 vs. 17.3 ± 0.2 g/d, p&lt;0.0001). Similarly, PN (19.8 ± 0.9 vs. 17.5 ± 0.2 g/d, p=0.0132) and PMD (19.7 ± 0.4 vs. 17.3 ± 0.2 g/d, p&lt;0.0001) consumers had higher fiber intakes than non‐consumers of these groups, respectively. Relatively few differences in intakes of calcium, potassium, and vitamin D were observed for overall pasta consumption. Potassium intake was significantly higher (2920 ± 65 mg/d vs. 2771 ± 18, p=0.02) and intake of vitamin D was significantly lower (4.3 ± 0.2 vs. 5.0 ± 0.1 μg/d, p=0.0079) when PN consumers were compared to non‐consumers. In conclusion, better diet quality was only associated with consumption of “Pasta, noodles and cooked grains (with a few exclusions for cooked grains)”; most of the changes in HEI scores resulted from associated lower consumption of solid fats, added sugars, and alcohol calories. Fiber intakes of pasta consumers, regardless of food groupings, were significantly higher. Given that daily fiber intakes in US adults are consistently below recommendations, strategies to increase fiber intake are warranted. Strategies to increase consumption of pasta with vegetables might help to further maximize fiber intakes, improve micronutrient intake, as well as diet quality in the US.Support or Funding InformationFunding provided by Barilla America, Inc.

Raisin Consumption is Associated with Increased Nutrient Intake, Better Diet Quality, and Lower Body Mass Index in Adult Participants (19+ years) from the NHANES (2001–2012)

The association between raisin consumption with nutrient intake, dietary quality, and weight parameters was examined in adults using data from National Health and Nutrition Examination Survey (NHANES), 2001–2012 (n=29,684). Raisin consumers (n=458, 60.1% female) were defined as reporting consumption of any amount of raisins during the first 24‐hour diet recall. Diet quality was calculated using the Healthy Eating Index‐2010 (HEI). Covariate adjusted (age, gender, race/ethnicity, poverty income ratio, physical activity level, current smoking status, and alcohol intake) regression analyses were conducted using appropriate sample weights; significance was set at p&lt;0.01. For analyses of nutrients and food groups energy intake was an additional covariate. Energy intake was higher in raisin consumers than non‐consumers (2257 ± 44 vs. 2074 ± 9). Examining nutrients of public health concern/shortfall nutrients identified by the Dietary Guidelines Advisory Committee Report 2015, dietary fiber (22.1 ± 1 vs. 16.5 ± 0.1 g/d) and potassium (3084 ± 77 vs. 2665 ± 10 mg/d) were significantly higher in raisin consumers compared to non‐consumers, while no associations were observed for intakes of calcium and vitamin D. Intakes of vitamin A, folate, and iron were similar in raisin consumers and non‐consumers but intake of vitamin C (117 ± 8 vs. 94.4 ± 1.2 mg/d), vitamin E (8.9 ± 0.5 vs. 7.3 ± 0.1 mg AT/d), and magnesium (355 ± 11 vs. 290 ± 1 mg/d) were higher in raisin consumers. Regarding nutrients to limit, intakes of saturated fatty acids (21. 2 ± 0.9 vs. 25.0 ± 0.1 g/day), added sugars (14.9 ± 0.7 vs. 18.0 ± 0.2 tsp equivalents/day), and sodium (3190 ± 78 vs. 3541 ± 17 mg/day) were significantly lower in the raisin consumers vs. non‐consumers. Consumers had higher total HEI scores (61.4 ± 1.0 vs. 49.1 ± 0.2). Regarding HEI sub‐components, except for total dairy and total protein, HEI sub‐component scores were higher for raisin consumers as compared to non‐consumers. The largest differences in sub‐component scores were seen for calories from solid fats, added sugars, and alcohol, (14.3 ± 0.4 vs. 12.1 ± 0.1), whole grains (4.2 ± 0.2 vs. 2.1 ± 0.04), and whole fruit (3.8 ± 0.2 vs. 2.1 ± 0.03). BMI (27.3±0.4 vs. 28.8±0.1 kg/m2) and waist circumference (94.1±0.1 vs. 97.8±0.2 cm) were lower in consumers. Raisin consumers were 39% less likely [odds ratio (OR):0.61, 99th confidence interval (CI): 0.41, 0.89] to be overweight or obese and had a 48% reduced risk (OR=0.58, 99th CI: 0.36, 0.74) of increased waist size. Raisin consumption was associated with better nutrient intake, diet quality and weight parameters in adults.Support or Funding InformationFunding provided by Sun‐Maid Growers of California and USDA.

Abstract MP11: Acculturation is Associated with a Higher Prevalence of Cardiometabolic Risk Factors in US Immigrants: An Analysis of the 2010-2014 National Health Interview Survey

Background: The burden of cardiometabolic disease and associated risk factors including overweight/obesity, diabetes and hypertension is high in ethnic minorities in the United States (US). The size of the immigrant population in the US continues to grow rapidly. It has been posited that acculturation to the US society results in an elevation or reduction of risk for cardiometabolic disease in immigrants. Hypothesis: We hypothesized that increased years of US residence (proxy measure for acculturation) would be associated with a higher prevalence of overweight/obesity, diabetes and hypertension, known risk factors for cardiometabolic disease, in US immigrants. Methods: We analyzed data on adult US immigrants in the National Health Interview Survey (NHIS) from 2010-2014. The immigrants were from the following 9 regions of birth: Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, India, Central and Southeast Asia. The main independent variable was length of US residence; &lt;10 years and ≥10 years. The main outcome variables were hypertension, overweight/obesity and diabetes. We used multivariable logistic regression to examine these associations and adjusted for known confounders. Results: Of the 54,984 immigrants, 62% were overweight/obese, 20 % had hypertension and 8% had diabetes. The mean age (± SE) was 43 (±0.15) years. Half were females and those who had resided in the US for ≥10 years were more likely to have health insurance coverage (70% vs 54%, p&lt;0.001) and older (46 years vs 35years, p&lt;0.001) compared to immigrants with &lt;10 years of duration of stay. After adjusting for region of birth, poverty income ratio, age and sex, we observed that immigrants residing in the US for ≥10 years were more likely to be overweight/obese (Odds Ratio[OR] 1.21, 95% CI 1.11-1.31), diabetic (OR: 1.58, 95% CI 1.32-1.90) and hypertensive(OR: 1.34, 95% CI 1.19-1.50) than those residing in the US for &lt;10 years. Conclusion: In an ethnically diverse sample of contemporary US immigrants, we found that increased length of US residence (acculturation) was associated with overall presence of cardiometabolic risk factors. Culturally-tailored public health strategies should be developed and implemented in immigrant sub-populations in the US to prevent the development of cardiometabolic disease.

Fusing Data Mining, Machine Learning and Traditional Statistics to Detect Biomarkers Associated with Depression.

BackgroundAtheoretical large-scale data mining techniques using machine learning algorithms have promise in the analysis of large epidemiological datasets. This study illustrates the use of a hybrid methodology for variable selection that took account of missing data and complex survey design to identify key biomarkers associated with depression from a large epidemiological study.MethodsThe study used a three-step methodology amalgamating multiple imputation, a machine learning boosted regression algorithm and logistic regression, to identify key biomarkers associated with depression in the National Health and Nutrition Examination Study (2009–2010). Depression was measured using the Patient Health Questionnaire-9 and 67 biomarkers were analysed. Covariates in this study included gender, age, race, smoking, food security, Poverty Income Ratio, Body Mass Index, physical activity, alcohol use, medical conditions and medications. The final imputed weighted multiple logistic regression model included possible confounders and moderators.ResultsAfter the creation of 20 imputation data sets from multiple chained regression sequences, machine learning boosted regression initially identified 21 biomarkers associated with depression. Using traditional logistic regression methods, including controlling for possible confounders and moderators, a final set of three biomarkers were selected. The final three biomarkers from the novel hybrid variable selection methodology were red cell distribution width (OR 1.15; 95% CI 1.01, 1.30), serum glucose (OR 1.01; 95% CI 1.00, 1.01) and total bilirubin (OR 0.12; 95% CI 0.05, 0.28). Significant interactions were found between total bilirubin with Mexican American/Hispanic group (p = 0.016), and current smokers (p<0.001).ConclusionThe systematic use of a hybrid methodology for variable selection, fusing data mining techniques using a machine learning algorithm with traditional statistical modelling, accounted for missing data and complex survey sampling methodology and was demonstrated to be a useful tool for detecting three biomarkers associated with depression for future hypothesis generation: red cell distribution width, serum glucose and total bilirubin.

Trends and variability in blood lead concentrations among US children and adolescents.

Using data from the National Health and Nutrition Examination Survey for the period 2003-2012, the objective of this study was to evaluate trends in blood lead levels (BLL) among children aged 1-5and 6-11years and smoker and nonsmoker adolescents aged 12-19years. Regression models with log10 transformed values of BLLs as dependent variable were fitted to evaluate how gender, race/ethnicity, smoking, and exposure to secondhand smoke at home affect BLLs. Irrespective of age, gender, and race/ethnicity, BLLs declined over the study period (p ≤ 0.01). Overall, adjusted BLLs declined by 0.00114μg/dL for every 2years. Children aged 1-5years had about 50% higher BLLs than smoker adolescents, about 75% higher BLLs than nonsmoker adolescents, and about 45% higher BLLs than children aged 6-11years. While overall, children aged 1-5years with BLL ≥ 5μg/dL made up 3.24%, 7.8% non-Hispanic Black children aged 1-5years had BLL ≥ 5μg/dL. Males were found to have higher adjusted BLLs than females, and non-Hispanic Blacks were found to have higher adjusted BLLs than non-Hispanic Whites. Higher poverty income ratio was associated with lower adjusted BLLs (β = -0.02916, p < 0.01). Children living in owner-occupied homes had lower adjusted BLLs than children living in renter-occupied homes. BLLs increased with increase in number of smokers smoking inside the home (β = 0.02496, p = 0.02). In conclusion, while BLLs have declined for all age groups, genders, and races/ethnicities, certain races/ethnicities like non-Hispanic Blacks continue to have substantially higher BLLs than non-Hispanic Whites.

Anal Intercourse and Fecal Incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey.

The aim of this study was to assess the prevalence and associations between anal intercourse and fecal incontinence. Analyses were based on data from 6,150 adults (≥20 years) from the 2009-2010 cycle of the National Health and Nutrition Examination Surveys. Fecal incontinence was defined as the loss of liquid, solid, or mucus stool occurring at least monthly on a validated questionnaire. A gender-specific sexual behavior questionnaire assessed any anal intercourse via an audio computer-assisted personal interview. Co-variables included: age, race, education, poverty income ratio, body mass index, chronic illnesses, depression, loose stool consistency (Bristol Stool Scale types 6 or 7), and reproductive variables in women. Prevalence estimates and prevalence odds ratios (PORs) were analyzed in adjusted multivariable models using appropriate sampling weights. Overall, 4,170 adults aged 20-69 years (2,070 women and 2,100 men) completed sexual behavior questionnaires and responded to fecal incontinence questions. Anal intercourse was higher among women (37.3%) than men (4.5%), P<0.001. Fecal incontinence rates were higher among women (9.9 vs. 7.4%, P=0.05) and men (11.6 vs. 5.3%, P=0.03) reporting anal intercourse compared with those not reporting anal intercourse. After multivariable adjustment for other factors associated with fecal incontinence, anal intercourse remained a predictor of fecal incontinence among women (POR: 1.5; 95% confidence interval (CI): 1.0-2.0) and men (POR: 2.8; 95% CI: 1.6-5.0). The findings support the assessment of anal intercourse as a factor contributing to fecal incontinence in adults, especially among men.

Association of Urinary Phthalates with Self-Reported Eye Affliction/Retinopathy in Individuals with Diabetes: National Health and Nutrition Examination Survey, 2001–2010

Background. An epidemiological association between exposure to phthalates and type 2 diabetes (T2D) is known. However, the potential role of environmental phthalates in the complications of T2D is unknown. Methods. Using data from the National Health and Nutrition Examination Survey (NHANES) 2001–2010, we studied the association of 12 urinary phthalate metabolites with self-reported eye affliction/retinopathy in 1,004 participants with diabetes. Data from retinal imaging was used to validate this outcome. Independence of the phthalates→T2D association was studied by adjusting for age, sex, race, marital status, educational attainment, poverty income ratio, physical activity, glycated hemoglobin levels, total serum cholesterol, serum high-density lipoprotein cholesterol, serum triglycerides, blood pressure, duration of diabetes, total calorie intake, and obesity. Results. Self-reported eye affliction/retinopathy had 82% accuracy with Cohen's kappa of 0.31 (p < 0.001). Urinary mono-n-octyl phthalate (MOP) was independently associated with the likelihood of self-reported eye affliction/retinopathy in subjects with T2D after accounting for all the confounders. This significance of this association was robust to the potential misclassification in cases and controls of retinopathy. Further, a significant dose-response relationship between MOP and self-reported eye affliction/retinopathy was demonstrable. Conclusions. We show a novel epidemiological link between the environment and diabetic complications in NHANES 2001–2010 participants.