Increased erythrocyte lead levels correlate with decreased hemoglobin levels in the Korean general population: analysis of 2008–2010 Korean National Health and Nutrition Examination Survey data

Introduction

We present data from the Korean National Health and Nutrition Examination Survey 2008–2010 on the association between blood lead and hemoglobin levels in a representative sample of the adult South Korean population.

Methods

The analysis was restricted to participants ≥20 years of age who completed the health examination survey, including blood lead measurements (n = 5,951). Multivariate linear regression analyses were performed to estimate adjusted mean differences in hemoglobin level associated with doubling of whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment. Odds ratios (ORs) for having borderline anemia or clinical anemia were calculated for log-transformed whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment.

Results

A twofold increase in whole blood lead or erythrocyte lead was associated with a 0.285 g/dL increase or 0.088 g/dL decrease in hemoglobin level, respectively. There was a 0.416 g/dL increase or 0.143 g/dL decrease in hemoglobin, respectively, in the highest, compared with the lowest tertile of whole blood lead and erythrocyte lead, respectively. Based on ORs, doubling of whole blood lead or erythrocyte lead resulted in a 36.3 % decrease or 36.2 % increase, respectively, in the risk of borderline anemia.

Conclusion

The association of whole blood lead versus erythrocyte lead with hemoglobin level was opposite. In the case of anemia, which is frequently caused by iron deficiency, the effect on the whole blood lead concentration may be very significant, leading to a considerable underestimation of the person’s lead status. Therefore, hematocrit-adjusted blood lead level (i.e., erythrocyte lead) should be applied to the general population. To our knowledge, this is the first study to show that erythrocyte lead levels showed a significant inverse relationship with hemoglobin level at lead levels <10 μg/dL in the general Korean population. In conclusion, increased erythrocyte lead levels may be associated with mildly decreased hemoglobin levels, after adjusting for covariates, in a representative sample of the adult Korean population.     

Association between blood lead and mercury levels and periodontitis in the Korean general population: analysis of the 2008–2009 Korean National Health and Nutrition Examination Survey data

Objectives

We present data from the Korean National Health and Nutrition Examination Survey 2008–2009 regarding the association between blood lead and mercury levels and periodontitis in a representative sample of the adult South Korean population.

Methods

The analysis was restricted to participants ≥20 years of age who completed the health examination survey, including blood lead, cadmium, and mercury measurements (n = 3,966). Odds ratios (ORs) for periodontitis were calculated for log-transformed blood metal levels and quartiles thereof after covariate adjustment.

Results

In a logistic regression analysis using log-transformed blood lead and mercury levels as independent variables after covariate adjustment, including blood lead, mercury, and cadmium, the ORs and 95 % CI values in men for having periodontitis with doubling of blood lead and mercury were 1.699 (1.154–2.503) and 1.394 (1.057–1.838), respectively. Furthermore, in a logistic regression analysis using tertiles of blood lead and mercury as independent variables after covariate adjustment, the ORs and 95 % CIs of men for having periodontitis in the highest tertile were 1.756 (1.184–2.604) and 1.575 (1.507–2.347), respectively. ORs in the logistic regression analysis for men using log-transformed blood cadmium or the tertile of blood cadmium as independent variables after covariate adjustments were not statistically significant in either model. Unlike men, ORs in the logistic regression analyses for women using the same independent variables after covariate adjustment were not statistically significant in any blood metal analysis.

Conclusions

The association between blood lead and mercury levels and periodontitis was significant regardless of the type of variable (continuous or categorical) in the Korean male population.     

Urinary levels of eight phthalate metabolites and bisphenol A in mother–child pairs from two Spanish locations

Exposure to some phthalate diesters and bisphenol A in the general population is a cause of increasing concern because of their potential adverse effects on the reproductive and endocrine systems and their broad presence in foodstuff and consumer products. The aims of this work are to assess patterns of exposure to phthalates and bisphenol A in a pilot sample of Spanish mothers and their children, and to provide basic information to address priorities in future Spanish surveys/research. Urinary levels of eight phthalate metabolites and bisphenol A have been measured in samples from 120 mother–child pairs in one rural and one urban location in central Spain, recruited as part of the European project DEMOCOPHES. More than 96% of the participants were exposed to all the compounds studied here with generally higher levels in children than their mothers. The sum of secondary DEHP metabolites gave a GM of 33.3 μg/g creatinine (95% CI 30.2–36.6) for mothers and 63.0 μg/g creatinine (95% CI 56.8–69.8) for children. Mono-ethyl phthalate (MEP) was the metabolite with the highest levels, with geometric means (GM) of 150.8 μg/g creatinine (95% CI 124.0–183.5) for mothers and 198.9 μg/g creatinine (95% CI 165.2–239.6) for children. Bisphenol A urinary levels were relatively low with geometric means of 2.0 μg/g (95% CI 1.6–2.4) for mothers and 2.01 μg/g (95% CI 1.7–2.4) for children. Personal care products like body lotions and fragrances showed associations with MEHP, MEP, MnBP and cx-MiNP and canteen food with MBzP and bisphenol A. Exposure of mothers and their children are correlated, except for MEP. As phthalates and bisphenol A are non-persistent chemicals, a daily, intermittent exposure of the population is taking place.     

A demographic,clinical, and behavioral typology of obesity in the United States: an analysis of National Health and Nutrition Examination Survey 2011–2012

Purpose

Public health reporting, randomized trials, and epidemiologic studies of obesity tend to consider it as a homogeneous entity. However, obesity may represent a heterogeneous condition according to demographic, clinical, and behavioral factors. We assessed the heterogeneity of individuals with obesity in the United States.

Trends in Prevalence of Overweight and Obesity in Korean Adults, 1998–2009: The Korean National Health and Nutrition Examination Survey

Background

Although obesity is increasing worldwide and becoming a major public health problem, some countries report a trend toward stabilization. We investigated prevalence trends in overweight/obesity and obesity among Korean adults during a 12-year period.

Methods

This study was based on the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998), II (2001), III (2005), and IV (2007–2009). The χ² and ANOVA tests were used to compare the prevalence and mean values for age and BMI, respectively. P-values for trends were determined by linear and logistic regression analyses, with KNHANES phase as the continuous variable.

Results

The prevalences of overweight/obesity in KNHANES I through IV were 50.8%, 57.4%, 62.5%, and 62.6%, respectively, among men (P for trend = 0.002, β = 0.021) and 47.3%, 51.9%, 50.0%, and 48.9% among women (P for trend = 0.017, β = −0.015). The respective prevalences of obesity were 26.0%, 32.4%, 35.1%, and 36.3% among men (P for trend = 0.006, β = 0.018) and 26.5%, 29.3%, 28.0%, and 27.6% among women (P for trend = 0.143, β = −0.008). During the same period, the respective prevalences of grade 2 obesity (BMI ≥30 kg/m²) were 1.7%, 2.8%, 3.6%, and 3.8% among men (P for trend = 0.075, β = 0.005) and 3.0%, 3.5%, 3.4%, and 4.0% among women (P for trend = 0.398, β = 0.003).

Conclusions

The prevalences of overweight/obesity and obesity showed an upward trend among men during the 12-year period, whereas the prevalence of overweight/obesity slightly decreased among women from 2001.Key words: obesity, overweight, prevalence, trend     

Socioeconomic status and dyslipidemia in Korean adults: The 2008–2010 Korea National Health and Nutrition Examination Survey

Objective

This study investigated the relationship between socioeconomic status (SES) and dyslipidemia and various parameters of dyslipidemia among Korean adults.

Methods

Data from the 2008–2010 Korea National Health and Nutrition Examination Survey were used in this study. A total of 19,041 Korean adults greater than 19 years old participated in the study. The SES was assessed by monthly household income and education level. The relationship of SES to the risk of dyslipidemia was assessed with multivariate logistic regression analysis after adjusting for potential confounders.

Results

The prevalence of dyslipidemia was 37.4% among Korean adults. In men, household income level was positively associated with prevalence and risks of several parameters of dyslipidemia, and education level had positive associations with the risks of dyslipidemia and parameters of dyslipidemia. However, low SES was linked to increased prevalence and risks of dyslipidemia (P for trend < 0.05) and parameters of dyslipidemia in women.

Conclusions

Socioeconomic disparities in dyslipidemia were found in the Korean population. Also, there were gender differences in the relationship between SES and dyslipidemia. These disparities should be considered when performing risk calculations and screening for dyslipidemia, which will ultimately help prevent cardiovascular disease.     

Blood cadmium concentrations in Korean adolescents: From the Korea National Health and Nutrition Examination Survey 2010–2013

Objective

To assess blood cadmium levels in Korean adolescents with respect to demographic and lifestyle factors.

Biomonitoring of phthalate metabolites in the Canadian population through the Canadian Health Measures Survey (2007–2009)

Human exposure to phthalates occurs through multiple sources and pathways. In the Canadian Health Measures Survey 2007–2009, 11 phthalate metabolites, namely, MMP, MEP, MnBP, MBzP, MCHP, MCPP, MEHP, MEOHP, MEHHP, MnOP, and MiNP were measured in urine samples of 6–49 year old survey respondents (n = 3236). The phthalate metabolites biomonitoring data from this nationally-representative Canadian survey are presented here. The metabolites MEP, MnBP, MBzP, MCPP, MEHP, MEOHP and MEHHP were detected in >90% of Canadians while MMP, MCHP, MnOP and MiNP were detected in <20% of the Canadian population. Step-wise regression analyses were carried out to identify important predictors of volumetric concentrations (μg/L) of the metabolites in the general population. Individual multiple regression models with covariates age, sex, creatinine, fasting status, and the interaction terms age × creatinine, age × sex and fasting status × creatinine were constructed for MEP, MnBP, MBzP, MCPP, MEHP, MEOHP and MEHHP. The least square geometric mean (LSGM) estimates for volumetric concentration (μg/L) of the metabolites derived from respective regression models were used to assess the patterns in the metabolite concentrations among population sub-groups. The results indicate that children had significantly higher urinary concentrations of MnBP, MBzP, MEHP, MEHHP, MEOHP and MCPP than adolescents and adults. Moreover, MEP, MBzP, MnBP and MEOHP concentrations in females were significantly higher than in males. We observed that fasting status significantly affects the concentrations of MEHP, MEHHP, MEOHP, and MCPP metabolites analyzed in this study. Moreover, our results indicate that the sampling time could affect the DEHP metabolite concentrations in the general Canadian population.     

Are Mothers’ Working Hours Associated with General and Abdominal Obesity in Children and Adolescents? The Korean National Health and Nutrition Examination Survey (2008–2012)

Objectives Despite an increase in the female work force and recent increase in childhood obesity, the association between working hours of mothers and childhood obesity as well as how such association differs according to mothers’ weight and intake frequency of energy-dense, nutrition-poor (EDNP) foods remain unclear. Methods Data from the Korean National Health and Nutrition Examination Survey (2008–2012) that included samples from 3914 children in 2526 households were analyzed. Two-level (household-children) mixed-effects modeling was performed to investigate the association between mothers’ working hours and childhood obesity based on body mass index (BMI) and waist circumference (WC). Results Long working hours (h) of mothers were associated with both BMI (β = ? 0.14; P = 0.324 for 1–20 h, β = 0.10; P = 0.334 for ≤ 21–40 h; β = 0.09; P = 0.429 for 41–68 h, β = 0.51; P = 0.015 for ≥ 69 h) and WC of the child (β = 0.06; P = 0.809 for 1–20 h; β = 0.46; P = 0.017 for ≤ 21–40 h; β = 0.59; P = 0.004 for 41–68 h, β = 1.35; P < 0.001 for ≥ 69 h), and the mean increase was greater for mothers working ≥ 69 h compared to those working 0 h. We also observed that the association between mothers’ working hours and child’s BMI and WC was greater for children whose mothers were either overweight or obese and frequently consumed energy-dense, nutrient-poor foods (EDNP). Conclusions for Practice Long working hours of mothers are associated with higher BMI and WC in children. Thus, it is important to improve labor welfare for mothers who work long hours, and provide interventions to promote good health behaviors in both children and working mothers.     

Gender differences in the associations between urinary bisphenol A and body composition among American children: The National Health and Nutrition Examination Survey, 2003–2006

Background

As an endocrine disruptor, bisphenol A (BPA) exposure has been implicated as a potential risk factor in childhood obesity, which is defined using percentiles of body mass index for age. We aimed to examine the associations between BPA exposure, reflected by urinary BPA concentration, and body composition in American children.

Urinary concentrations of dichlorophenol pesticides and obesity among adult participants in the U.S. National Health and Nutrition Examination Survey (NHANES) 2005–2008

Accumulating evidence from recent studies has suggested a possible link between exposure to environmental pesticides and obesity. In this study, we assessed the potential associations between exposure to dichlorophenol pesticides and obesity in adults. Study participants aged 20–85 years were selected from the 2005 to 2006 and 2007 to 2008 U.S. National Health and Nutrition Examination Survey, and were categorized as obese and non-obese based on body mass index. Creatinine-corrected urinary concentrations of dichlorophenols were determined to assess level of exposure to environmental pesticides. Multivariate logistic regression was performed using SAS 9.3 to assess the association between 2,4-dichlorophenol (2,4-DCP) and 2,5-dichlorophenol (2,5-DCP) levels in urine and obesity with adjustment for potential confounders. Significantly higher geometric means of urinary concentrations of both 2,5-DCP (p < 0.0001) and 2,4-DCP (p = 0.0170) were seen in obese adults, compared to that in non-obese adults. A dose-dependent increase in the prevalence of obesity was observed in the study participants across increasing levels of urinary 2,5-DCP (p-trend < 0.0001). Urinary concentrations of 2,5-DCP were significantly associated with obesity among the second (AOR: 1.47, 95% CI: 1.12, 1.93), third (AOR: 1.41, 95% CI: 1.07, 1.87), and fourth (AOR: 1.62, 95% CI: 1.21, 2.17) inter-quartiles after adjustment for age, gender, race, education, total fat intake, and physical activity. A statistically significant association was not seen between urinary 2,4-DCP and obesity. Our findings suggest a potential relationship between exposure to the fumigant insecticide paradichlorobenzene, measured as urinary concentrations of 2,5-DCP, and obesity in adults. Because we cannot rule out the possibility of reverse causality in our study, prospective studies measuring exposure during etiologically relevant periods are warranted.     

Urinary parabens and triclosan concentrations and associated exposure characteristics in a Korean population—A comparison between night-time and first-morning urine

Parabens and triclosan have been widely used in many personal care products and cosmetics. The endocrine disrupting potential of these compounds is of increasing public health concern. The aim of this study is to understand the current exposure profile of these chemicals in last void before bedtime (night-time) and first-morning void (first-morning) urines among a Korean population and to characterize their exposure sources and pathways.A total of 261 people, including infants (0–2 years), toddlers (3–6 years), children (7–12 years), adolescents (13–18 years), and adults (≥19 years), were recruited, and sampled for night-time urine and first-morning urine of the following day. Methyl (MeP), ethyl (EtP), propyl (PrP) and butyl paraben (BuP), and triclosan were measured in urine. The demographic characteristics, use of personal care products, and food consumption were obtained through a questionnaire.Among the target compounds, EtP and MeP were most frequently detected at the highest concentrations. The median concentration of EtP in night-time urine was 32.4?μg/L (interquartile range: 8.37–82.8?μg/L), which is higher than previously reported worldwide. Unlike other test compounds, compared to those measured from first-morning urine, the EtP concentrations were significantly higher in night-time urine, suggesting the presence of different exposure sources. Among adults, the MeP and PrP concentrations in night-time urine were associated with frequent use of skin care products, colored cosmetics, bath products, toothpaste, vinyl food packaging, or consumption of canned food. The MeP and PrP concentrations were higher in females than in males, especially in night-time urine. The results of this study also show that multiple urine samples are necessary to capture the diurnal variation of non-occupational exposure to environmental chemicals, such as parabens.     

Prevalence and Associated Factors of Tinnitus: Data From the Korean National Health and Nutrition Examination Survey 2009–2011

Background

Tinnitus is a common condition and frequently can be annoying to affected individuals. We investigated the prevalence and associated factors for tinnitus in South Korea using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2009–2011.

Methods

KNHANES is a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 21 893). A field survey team that included an otolaryngologist moved with a mobile examination unit and performed interviews and physical examinations.

Results

Among the population over 12 years of age, the prevalence of any tinnitus was 19.7% (95% CI 18.8%–20.6%). Tinnitus was more prevalent in women, and the prevalence rate increased with age (P < 0.001). Among those with any tinnitus, 29.3% (95% CI 27.3%–31.3%) experienced annoying tinnitus that affected daily life. Annoying tinnitus also increased with age (P < 0.001), but no sex difference was demonstrated (P = 0.25). In participants aged 40 years or older, age, quality of life, depressive mood, hearing loss, feeling of dizziness, and rhinitis were associated with any tinnitus (P < 0.05). Age, hearing loss, history of cardiovascular disease, and stress were associated with annoying tinnitus (P < 0.05).

Conclusions

Tinnitus is a common condition, and a large population suffers from annoying tinnitus in South Korea. Public understanding of associated factors might contribute to better management of tinnitus.Key words: tinnitus, epidemiology, associated factor, South Korea     

What are patient factors associated with the quality of diabetes care?: results from the Korean National Health and Nutrition Examination Survey

ABSTRACT: BACKGROUND: Recently there has been a growing interest in healthcare quality control in Korea. We examined the association between patient factors and quality indicators of diabetic care among Korean adults with diabetes. METHODS: We obtained a sample of 335 adults aged 20 or older diagnosed with diabetes from the 2005 Korean National Health and Nutrition Examination Survey. Patient factors were divided into two categories: socioeconomic position and health-related factors. Quality indicators for diabetes care were defined as receiving preventive care services for diabetes complications (e.g., fundus examination, microalbuminuria examination, diabetes education) and diabetes-related clinical outcomes (e.g., HbA1c, blood pressure, LDL-cholesterol). We performed multiple logistic regression analyses for each quality indicator. RESULTS: We found that people with lower education levels or shorter duration of diabetes illness were less likely to receive preventive care services for diabetes complications. Women or people with longer duration of diabetes were less likely to reach the glycemic target. Obese diabetic patients were less likely to accomplish adequate control of blood pressure and LDL-cholesterol. CONCLUSIONS: Several factors of patients with diabetes, such as education level, duration of illness, gender, and obesity grade are associated with the quality of diabetes care. These findings can help inform policy makers about subpopulations at risk in developing a public health strategy in the future.     

Sexual orientation measurement and chronic disease disparities: National Health and Nutrition Examination Survey, 2009–2014

Purpose

To examine chronic disease disparities by sexual orientation measurement among sexual minorities.

Allostatic Load in Foreign-Born and US-Born Blacks: Evidence From the 2001–2010 National Health and Nutrition Examination Survey

Objectives. We tested whether the immigrant health advantage applies to non-Hispanic Black immigrants and examined whether nativity-based differences in allostatic load exist among non-Hispanic Blacks.Methods. We used pooled data from the 2001–2010 National Health and Nutrition Examination Survey to compare allostatic load scores for US-born (n = 2745) and foreign-born (n = 152) Black adults. We used multivariate logistic regression techniques to assess the association between nativity and high allostatic load scores, controlling for gender, age, health behaviors, and socioeconomic status.Results. For foreign-born Blacks, length of stay and age were powerful predictors of allostatic load scores. For older US-born Blacks and those who were widowed, divorced, or separated, the risk of high allostatic load was greater.Conclusions. Foreign-born Blacks have a health advantage in allostatic load. Further research is needed that underscores a deeper understanding of the mechanisms driving this health differential to create programs that target these populations differently.There is growing interest in improving population health because Healthy People 2020 and the Patient Protection and Affordable Care Act include important provisions to reduce health disparities.1,2 Recent research suggests that certain racial/ethnic groups in the United States, particularly non-Hispanic Blacks, have higher rates of morbidity and all-cause mortality than do Whites. However, non-Hispanic Blacks are a heterogeneous group that includes a growing population of immigrants from a variety of countries and cultural backgrounds. Recent estimates suggest the foreign-born segment of the Black population has almost tripled over the past 3 decades—with the majority migrating from the Caribbean and Africa—and represents roughly 8% of the Black population.3,4 Despite this marked increase, little is known about the health of foreign-born Blacks.Previous research suggests that Caribbean and African immigrants differ from their US-born counterparts in various physical5–8 and mental health indicators.9 Some research suggests that foreign-born Blacks have better health outcomes than do US-born Blacks because of the healthy immigrant effect.10,11 The healthy immigrant effect posits that immigrants have healthier lifestyles in their home countries, are among the healthiest from their home country, and are the group most willing and able to endure the stressors associated with immigration, therefore placing them at a health advantage. However, the health advantage declines with increased time spent in the United States, as immigrants adapt to the US sociocultural environment.10 Research suggests Caribbean and African immigrants have worse health over time because they have higher levels of psychological stress related to immigration and adjusting to new sociocultural environments.9 Additionally, the impact of exposure to racism in the United States may be particularly stressful for immigrants from regions of the world where they were a demographic majority.8,9To measure the deleterious effects of stress on the body, the concept of allostatic load has been introduced as a unique approach to understanding the underlying biological processes that might explain health vulnerability. Allostatic load accounts for the cumulative impact of physiological responses to acute, chronic, or long-term psychosocial stressors generated by social conditions that continuously activate hormonal responses to stressful conditions. Prolonged activation of these physiological systems is thought to place persons at risk for the development for both physical and mental disorders.12,13 The literature on allostatic load suggests that overexposure to adverse conditions while adapting to US culture can create a buildup of stressors endemic to the immigrant experience, particularly for immigrants of color.Some studies document the deleterious effects for foreign-born populations of psychosocial stress on the body and dysregulation of physiological systems known to protect the individual from disease.14 Much of this research has focused on Hispanics, partly because they are one of the largest immigrant ethnic groups, there is available survey data, and there is scientific interest in the Hispanic health paradox.15,16 This paradox—that Hispanics exhibit better health outcomes than do non-Hispanic Whites despite their lower than expected socioeconomic status—has been challenged in various studies in which time in the United States has been shown to be the predictor that is most associated with health declines.17 Kaestner et al.18 found that with increased time in the United States, the probability of having a high allostatic load score increased for foreign-born Mexicans. Peek et al.19 reported that among foreign-born Mexicans, those who had lived in the United States for more than 10 years were more likely to have high allostatic load scores. In this way, allostatic load offers a viable reason for the health decline among immigrants but has not been extensively studied in foreign-born Black populations.The only study to investigate the association between allostatic load and chronic health conditions for a population of Latinos that can identify themselves as Black or of African descent20 found that increasing allostatic load scores were significantly associated with abdominal obesity, hypertension, diabetes, self-reported cardiovascular disease, and arthritis for Puerto Ricans.21 However, to our knowledge, no study has examined the relationship between nativity and allostatic load among US- and foreign-born Blacks. Testing this hypothesis will provide knowledge about whether allostatic load operates in a similar way for this understudied population as evidenced in the Latino immigrant literature. We used the 2001–2010 National Health and Nutrition Examination Survey (NHANES)—one of the largest surveys designed to assess the health and nutritional status of adults residing in the United States—to examine nativity-based differentials in allostatic load. On the basis of previous research on immigrant health, we expected to observe a health advantage in allostatic load for foreign-born over US-born Blacks similar to what has been documented in studies focused on Mexican-born individuals.