Neighborhood deprivation and health risk behaviors in NHANES III

OBJECTIVE: To examine whether neighborhood-level socioeconomic status is an independent risk factor for health risk behaviors. METHODS: Data from the Third National Health and Nutrition Examination Survey were linked with census tracts from the 1990 US Census. Outcome variables included biomarkers for smoking and high dietary fat intake, and self-reported excessive alcohol consumption and physical inactivity. RESULTS: Multivariate logistic regression showed an association between high levels of neighborhood deprivation and increased odds of health risk behaviors independent of sociodemographic factors, BMI, and comorbidities. CONCLUSION: Living in highly deprived neighborhoods is associated with risky health behaviors.     

Serum ascorbic acid and cardiovascular disease prevalence in U.S. adults: the Third National Health and Nutrition Examination Survey (NHANES III).

PURPOSE: To examine the relation between serum ascorbic acid concentration, which reflects dietary and supplement intake, and the prevalence of cardiovascular disease. METHODS: We analyzed data from 7658 men and women enrolled in the Third National Health and Nutrition Examination Survey (NHANES III). We calculated odds ratios and 95% confidence intervals (CI) to estimate the relative prevalence of cardiovascular disease, defined as self-reported angina, myocardial infarction, or stroke. Because we detected an interaction between serum ascorbic acid concentration and alcohol intake, we performed analyses stratified by drinking status. RESULTS: Among participants who reported no alcohol consumption, serum ascorbic acid concentrations were not independently associated with cardiovascular disease prevalence. Among participants who consumed alcohol, serum ascorbic acid concentrations consistent with tissue saturation (1.0-3.0 mg/dl) were associated with a decreased prevalence of angina (multivariate odds ratio (OR): 0.48; 95% CI: 0.23% to 1.03; p for trend = 0.06), but were not significantly associated with myocardial infarction or stroke prevalence. CONCLUSIONS: These results suggest the possibility of a biologic interaction between ascorbic acid and alcohol and that higher intakes of ascorbic acid may be associated with a decreased risk of angina among drinkers.     

Household Food Insecurity,Lung Function,and COPD in US Adults

Increasing epidemiological evidence suggests that optimal diet quality helps to improve preservation of lung function and to reduce chronic obstructive pulmonary disease (COPD) risk, but no study has investigated the association of food insecurity (FI) and lung health in the general population. Using data from a representative sample of US adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2007–2012 cycles, we investigated the association between FI with lung function and spirometrically defined COPD in 12,469 individuals aged ≥ 18 years of age. FI (high vs. low) was defined using the US Department of Agriculture’s Food Security Scale). Population-weighted adjusted regression models were used to investigate associations between FI, and forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), their ratio, and spirometrically defined restriction (FVC below the lower limit of normal) and airflow obstruction (COPD). The prevalence of household FI was 13.2%. High household FI was associated with lower FVC (adjusted β-coefficient −70.9 mL, 95% CI −116.6, −25.3), and with higher odds (OR) of spirometric restriction (1.02, 95% CI 1.00, 1.03). Stratified analyses showed similar effect sizes within specific ethnic groups. High FI was associated with worse lung health in a nationally representative sample of adults in the US.     

Comorbidity between and risk factors for severe hearing and memory impairment in older Americans

OBJECTIVE: Comorbidities complicate our understanding of impairments and their risk factors. The objective of the current study was to assess the comorbidity between hearing impairment (HI) and memory impairment (MI) in older Americans and to assess to what extent they share common risk factors. METHOD: Data were examined from 5252 participants aged 65 years or older from the Third National Health and Nutrition Examination Survey (1988-1994). RESULTS: The prevalence of HI and MI was 21.4 (SE 0.8)% and 8.3 (0.6)%, respectively, but the prevalence of concurrent impairment was only 2.1 (0.2)%. African Americans had higher odds of MI than whites (OR=3.75, 95% CI: 2.81, 5.00), but not of HI (OR=0.62, 95% CI: 0.42, 0.91). Leisure physical activity was associated with lower odds of MI, good lung function was associated with lower odds of HI, and moderate alcohol use was associated with lower odds of both HI and MI. Compared with individuals free of HI, the OR of MI was 1.07 (95% CI: 0.78, 1.47) for individuals with HI. CONCLUSION: Although prevalence was relatively high, comorbidity was surprisingly low, and the two impairments were not significantly associated. In addition to age, other factors appear to play critical but different roles in the development of these impairments.     

Association between household income and overweight of Korean and American children: trends and differences

The prevalence of overweight in children has been dramatically increasing worldwide, and socioeconomic status is an important risk factor. The purpose of this study was to examine the hypothesis that household income is negatively associated with overweight in Korean and American girls and boys. In the study, 2117 children 7 to 12 years of age from the Korean National Health and Nutrition Examination Survey between 2001 and 2007 and 3016 children from the US National Health and Nutrition Examination Survey between 2001 and 2006 were included. Overweight is defined as the sex- and age-specific body mass index cutoffs recommended by the International Obesity Task Force. Lower household income significantly increased the risk for overweight in Korean boys, irrespective of adjustments. The negative association between household income and overweight of American boys disappeared after adjusting for the frequency of dining out and TV viewing time. There was no significant association between household income and overweight of Korean and American girls. As household income increased, the intake of energy from protein was increased, but energy from carbohydrates was decreased in Korean boys. On the other hand, as household income increased, energy intake from carbohydrates was increased and energy intake from proteins decreased in American boys. In conclusion, positive association between household income and overweight was found in Korean boys, but not in Korean girls and American boys and girls. Effects solely targeting reduction in income disparities cannot effectively reduce sex disparities in overweight of children.     

Antioxidant nutrients and pulmonary function: the Third National Health and Nutrition Examination Survey (NHANES III)

Recent studies of chronic obstructive pulmonary disease have raised interest in its relation to nutrition. Several dietary antioxidants have been positively associated with lung function in healthy, general population samples. This study considered the separate and joint effects of vitamin C, vitamin E, beta-carotene, and selenium intake and used both dietary assessment and serum biomarkers of antioxidant status. The authors used data from the Third National Health and Nutrition Examination Survey comprising a sample representative of the US population in 1988-1994 (n = 18,162 subjects aged > or =17 years). Multiple linear regression analysis examined the separate and joint effects of the antioxidants on the ratio of forced expiratory volume in the first second (FEV1)/height2 adjusted for covariates. Each of the dietary and serum antioxidant nutrients was significantly associated with FEV1. When they were considered simultaneously (dietary and serum variables considered in separate models), independent associations were observed for most nutrients. Serum beta-carotene was less positively associated with FEV1 in smokers than nonsmokers, while serum selenium had a stronger positive association with FEV1 in smokers. The authors found that higher levels of antioxidant nutrients are associated with better lung function. The finding that the antioxidants differ in both their overall association with lung function and in whether this association varies by smoking status has implications for further research.     

Sex-specific relationships between alcohol consumption and vitamin D levels: The Korea National Health and Nutrition Examination Survey 2009

This study assessed the association between vitamin D sufficiency (serum 25(OH)D ≥30 ng/mL) and alcohol consumption using data from the Korea National Health and Nutrition Examination Survey conducted in 2009. The following characteristics were obtained in 7,010 Korean participants ≥19-years-of-age: serum 25(OH)D level, alcohol consumption (drinking frequency, drinking number of alcoholic beverages on a typical occasion, average daily-alcohol intake), and potential confounders (age, residence, housing status, occupation, total fat and lean mass, smoking, physical activity, history of liver diseases, liver function, and daily intake of energy, protein, and calcium). After adjusting for confounders, vitamin D sufficiency in men was significantly associated with drinking frequency, number of alcoholic drinks consumed, and average daily alcohol intake; odds ratio of 1.21-1.72, 2.17-3.04, and 2.27-3.09, respectively. Increase in the three alcohol drinking-related behaviors was also linearly associated with increase in serum 25(OH)D level in men. By comparison, there was no significant association between alcohol intake and serum 25(OH)D level in women. The positive association between vitamin D sufficiency and alcohol consumption was evident only in Korean men.     

Association between chronic obstructive pulmonary disease and employment by industry and occupation in the US population: a study of data from the Third National Health and Nutrition Examination Survey

Data from the US population-based Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994, were used to estimate the population prevalence, prevalence odds ratios, and attributable fractions for the association of chronic obstructive pulmonary disease (COPD) with employment by industry and occupation. The aim was to identify industries and occupations at increased risk of COPD. COPD was defined as forced expiratory volume in 1 second (FEV(1))/forced vital capacity <70% and FEV(1 )<80% predicted. The authors used SUDAAN software (Research Triangle Institute, Research Triangle Park, North Carolina) to estimate the weighted population prevalence and odds ratios using 9,823 subjects aged 30-75 years who underwent lung function tests. Odds ratios for COPD, adjusted for age, smoking status, pack-years of smoking, body mass index, education, and socioeconomic status, were increased for the following industries: rubber, plastics, and leather manufacturing; utilities; office building services; textile mill products manufacturing; the armed forces; food products manufacturing; repair services and gas stations; agriculture; sales; construction; transportation and trucking; personal services; and health care. Occupations associated with increased odds ratios for COPD were freight, stock, and material handlers; records processing and distribution clerks; sales; transportation-related occupations; machine operators; construction trades; and waitresses. The fraction of COPD attributable to work was estimated as 19.2% overall and 31.1% among never smokers.     

Association between dietary arginine and C-reactive protein

OBJECTIVE: We investigated whether a dietary intake of arginine is associated with risk for cardiovascular disease as determined by levels of C-reactive protein (CRP). METHODS: We analyzed the Third National Health Nutrition and Examination Survey, a national public-use dataset collected between 1988 and 1994. Arginine intake was calculated from the 24-h dietary recall using the nutrient composition database of the University of Minnesota Nutrition Coordinating Center. A logistic regression model was used to evaluate the relation between arginine intake and serum levels of CRP while controlling for age, sex, race, exercise, total caloric intake, body mass index, smoking status, diabetes, hypertension, and fiber intake. RESULTS: In the unadjusted model, the likelihoods of having a high level of CRP (>3.0 mg/L), from the lowest to the highest level of arginine intake, were 34.8%, 31.0%, 27.7%, and 18.4% respectively. Arginine intake below the median range was associated with higher levels of CRP (P < 0.05), and arginine intake above the median range was associated with lower levels of CRP (P < 0.05). In the adjusted regression, subjects in the highest level (90th percentile) of arginine intake were 30% less likely to have a CRP above 3.0 mg/L than were subjects with a median arginine intake (odds ratio= 0.70, 95% confidence interval = 0.56 to 0.88). CONCLUSIONS: The results of this study show a relation between arginine intake and CRP level that persisted after controlling for factors associated with CRP. Individuals may be able to lower their risk for cardiovascular disease by consuming more arginine-rich foods such as nuts and fish.     

Moderate alcohol intake is associated with decreased risk of insulin resistance among individuals with vitamin D insufficiency

ObjectiveTo determine whether moderate alcohol intake modifies the association between low vitamin D levels and insulin resistance (IR), we hypothesized that moderate alcohol intake would have a modifying effect on IR in people with low vitamin D levels.MethodsThis was a cross-sectional analysis of subjects ≥20 y old without a history of diabetes, coronary heart disease, or stroke in the National Health and Nutrition Examination Survey 2001–2004. Main outcome was IR status measured by homeostasis model assessment for IR (HOMA-IR; ≥ 2.6) and fasting insulin (>12.2 μU/mL) in moderate drinkers compared with non-drinkers by vitamin D levels (deficient ≤20 ng/mL, insufficient 21–32 ng/mL, normal >32 ng/mL).ResultsTwo thousand seven hundred twenty-one subjects met the inclusion criteria, representing a weighted total of >138 million people. Of these, 34% were vitamin D deficient and 47% insufficient. In adjusted analysis, compared with moderate drinkers with normal vitamin D levels, non-drinkers had no increased risk of IR by HOMA-IR levels (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.61–2.30). Vitamin D–deficient individuals had a higher risk of IR regardless of alcohol consumption (moderate drinkers OR 2.12, 95% CI 1.41–3.19; non-drinkers OR 2.22, 95% CI 1.29–3.83). However, in those with insufficient vitamin D levels, moderate alcohol intake had a modifying effect on the odds of IR, with no difference seen in moderate drinkers (OR 1.29, 95% CI 0.92–1.80) and an increased risk found in non-drinkers (OR 1.82, 95% CI 1.07–3.11). Similar results were seen with fasting insulin.ConclusionModerate alcohol consumption appears to have a modifying effect on the risk of IR in individuals with insufficient levels of vitamin D.     

Association of Magnesium Intake with Liver Fibrosis among Adults in the United States

Liver fibrosis represents the consequences of chronic liver injury. Individuals with alcoholic or nonalcoholic liver diseases are at high risk of magnesium deficiency. This study aimed to evaluate the association between magnesium and calcium intakes and significant liver fibrosis, and whether the associations differ by alcohol drinking status. Based on the National Health and Nutrition Examination Survey (NHANES) 2017–2018, the study included 4166 participants aged >18 years who completed the transient elastography examination and had data available on magnesium intake. The median liver stiffness of 8.2 kPa was used to identify subjects with significant fibrosis (≥F2). The age-adjusted prevalence of significant fibrosis was 12.81%. Overall total magnesium intake was marginally associated with reduced odds of significant fibrosis (p trend = 0.14). The inverse association of total magnesium intake with significant fibrosis was primarily presented among those who had daily calcium intake <1200 mg. There were no clear associations for significant fibrosis with calcium intake. Findings suggest that high total magnesium alone may reduce risk of significant fibrosis. Further studies are needed to confirm these findings.     

Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey

OBJECTIVE: Congestive heart failure (CHF) has been associated with insulin resistance, but few studies have examined its relationship with metabolic syndrome (MetS). Little is known about whether insulin resistance explains the association between MetS and CHF. DESIGN: Population-based, cross-sectional surveys. SETTING: Third National Health and Nutrition Examination Survey (NHANES III). PARTICIPANTS: Data from 5549 men and non-pregnant women aged > or =40 years in NHANES III were analysed. RESULTS: About 4% of men and 3% of women had CHF between 1988 and 1994 in the US. The age-adjusted prevalence of CHF was significantly higher in African Americans (4.1%), in Mexican Americans (8.5%) and in those of other ethnic origin (6.7%) than in white people (2.5%). People with MetS had nearly twice the likelihood of self-reported CHF (adjusted odds ratio 1.8; 95% confidence interval 1.1 to 3.0) after adjustment for demographic and conventional risk factors such as sex, ethnicity, age, smoking, total cholesterol, left ventricular hypertrophy, and probable or possible myocardial infarction determined by electrocardiography. However, this association was attenuated after further adjustment for insulin resistance as measured by the homoeostasis model assessment (HOMA). >90% of the association between MetS and CHF was explained by the HOMA. CONCLUSIONS: MetS was associated with about a twofold increased likelihood of self-reported CHF and it may serve as a surrogate indicator for the association between insulin resistance and CHF.     

Moderate drinking and coronary heart disease mortality: evidence from NHANES I and the NHANES I Follow-up.

Data from the National Health and Nutrition Examination Survey, conducted from 1971 through 1974, and the National Health and Nutrition Examination Survey Follow-up, conducted from 1982 through 1984, were used to test for a beneficial effect of moderate alcohol consumption on coronary heart disease mortality among White men and women. Evidence of such an effect was found for White men; accelerated time-to-failure models showed 3% to 4% longer life spans for moderate drinkers than for nondrinkers or light drinkers.     

Race and the prevalence of syphilis seroreactivity in the United States population: a national sero-epidemiologic study.

We used the 1978 National Health and Nutrition Examination Survey to examine the prevalence of positive syphilis serologies in the US population. Analysis of risk markers--gender, age, marital status, education, income, and residence--indicates that all except gender are associated with syphilis seroreactivity, independent of race. Controlling for associated risk markers, the Black-White odds ratio of syphilis seroreactivity is 4.7 (95% CI = 2.7, 8.2). Current knowledge of racial differences in sexual and health care behavior does not explain the Black-White difference in the prevalence of syphilis seroreactivity.     

Association between reported alcohol intake and cognition: results from the Women's Health Initiative Memory Study

Some, but not all, observational studies have suggested that moderate levels of alcohol intake may be associated with improved cognitive function and reduced risk of cognitive decline and dementia. The authors of this 1996-2002 study used data from the Women's Health Initiative Memory Study of postmenopausal combination hormone therapy to assess cross-sectional and prospective associations of self-reported alcohol intake with cognitive function. Across 39 US academic medical centers, 4,461 community-dwelling women aged 65-79 years were followed an average of 4.2 years with annual Modified Mini-Mental State Examinations and standardized protocols for detecting mild cognitive impairment and probable dementia. Compared with no intake, intake of > or =1 drink per day was associated with higher baseline Modified Mini-Mental State Examination scores (p < 0.001) and a covariate-adjusted odds ratio of 0.40 (95% confidence interval: 0.28, 0.99) for significant declines in cognitive function. Associations with incident probable dementia and mild cognitive impairment were of similar magnitude but were not statistically significant after covariate adjustment. Associations with intakes of <1 drink per day were intermediate. Moderate levels of alcohol intake may be associated with better cognition and reduced risk of significant cognitive decline; however, confounding associations with unmeasured factors cannot be ruled out.     

Nutritional and health consequences are associated with food insecurity among U.S. elderly persons

The purpose of this study was to examine the consequences associated with food insecurity for the nutritional and health status of the elderly in the United STATES: The data analyzed were from the Third National Health and Nutrition Examination Survey (1988-1994) and the Nutrition Survey of the Elderly in New York State (1994). Multiple logistic and linear regression analyses were used to assess the extent to which food-insecure elderly were likely to have lower nutrient intake, skinfold thickness, self-reported health status and higher nutritional risk. Regardless of food insecurity status, older people consumed less than the recommended dietary allowance for eight nutrients. Food-insecure elderly persons had significantly lower intakes of energy, protein, carbohydrate, saturated fat, niacin, riboflavin, vitamins B-6 and B-12, magnesium, iron and zinc, as well as lower skinfold thickness. In addition, food-insecure elderly persons were 2.33 (95% confidence interval: 1.73-3.14) times more likely to report fair/poor health status and had higher nutritional risk. These results indicate that food-insecure elderly persons have poorer dietary intake, nutritional status and health status than do food-secure elderly persons. It is necessary to ensure the nutritional well-being of all elderly persons who are at nutritional and health risk, including those who are food insecure and have even poorer nutritional and health status than those who are food secure.     

Variation in L-arginine intake follow demographics and lifestyle factors that may impact cardiovascular disease risk

Little is known regarding the patterns of dietary intake of the amino acid l-arginine in the general population and, particularly, whether intake varies according to race or the presence of cardiovascular risk factors. This study is an analysis of adults 18 years and older who participated in the Third National Health and Nutrition Examination Survey, a national public-use nutrition survey of noninstitutionalized persons. Mean arginine intake for the US adult population was 4.40 g/d, with 25% of people consuming less than 2.6 g/d. Minorities, obese individuals, and people with diabetes consumed more arginine per 4.19 kJ than people without those characteristics. Whites had consistently lower intake than African Americans and Hispanics. Smokers had lower intake than nonsmokers. After adjustment for demographic factors and energy intake, women and smokers remained more likely to be in the lowest quartile of arginine consumption. Hypertension status was not significantly related to arginine consumption. In conclusion, l-arginine intake varies according to demographic and cardiovascular risk factors in the population. These results may have implications for cardiovascular risk.     

Serum vitamin levels and the risk of asthma in children

Dietary intake, especially of antioxidant vitamins A, C, E, and the carotenoids, has been linked with the presence and severity of asthma. From the Third National Health and Nutrition Examination Survey (NHANES III), conducted in the United States between 1988 and 1994, the authors selected 4,093 children (aged 6-17 years) for whom relevant medical, socioeconomic, and anthropometric data were complete. The children were 50.6% female, and 9.7% reported a diagnosis of asthma. Bivariate analyses showed that asthma diagnosis was associated with lower levels of serum vitamin C, alpha-carotene, beta-carotene, and beta-cryptoxanthin. However, antioxidant levels may be surrogate markers for socioeconomic variables such as race, poverty, tobacco exposure, or general nutritional status. In logistic models that included age, body mass index, socioeconomic variables, antioxidant levels, parental asthma, and household smoking, the only antioxidants significantly associated with asthma were vitamin C (odds ratio = 0.72 per mg/dl, 95% confidence interval = 0.55, 0.95) and alpha-carotene (odds ratio = 0.95 per micro g/dl, 95% confidence interval = 0.90, 0.99). The odds ratio for asthma in the highest quintile of serum vitamin C relative to the lowest was 0.65 (p < 0.05), whereas it was 0.74 for alpha-carotene (p = 0.066). The authors concluded that low vitamin C and alpha-carotene intakes are associated with asthma risk in children.     

Healthy Eating Index and C-reactive protein concentration: findings from the National Health and Nutrition Examination Survey III, 1988-1994

OBJECTIVE: To examine whether diet quality is associated with C-reactive protein concentration. DESIGN: Cross-sectional study using data from the Third National Health and Nutrition Examination Survey (1988-1994). SETTING: Representative sample of the US population. SUBJECTS: A total of 13 811 men and women aged >/=20 y. INTERVENTIONS: We examined the cross-sectional associations between the Healthy Eating Index (HEI), a measure of diet quality according to the Dietary Guidelines for Americans, and serum C-reactive protein concentration. Dietary information was assessed using a 24-h recall. RESULTS: After adjustment for age, sex, race or ethnicity, education, smoking status, cotinine concentration, body mass index, waist-hip-ratio, aspirin use, alcohol use, physical activity level, and energy intake, HEI score was inversely associated with an elevated C-reactive protein concentration in logistic regression analysis (odds ratio per 10 unit change: 0.92; 95th confidence interval (CI): 0.86-0.99). Among the components, only the score for grain consumption was inversely associated with an elevated C-reactive protein concentration. Compared with participants in the lowest quintile of number of servings of grain consumption, the adjusted odds ratios of having an elevated C-reactive protein concentration for participants in the second, third, fourth, and fifth quintiles were 0.87 (95th CI: 0.67, 1.12), 0.85 (95th CI: 0.69, 1.06), 0.79 (95th CI: 0.65, 0.96), and 0.68 (95th CI: 0.52, 0.88), respectively. CONCLUSIONS: Grain consumption may reduce inflammation. Our findings require confirmation.