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.     

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     

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.     

Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010

Objectives

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods

We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results

The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions

We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.     

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     

Temporal Trends in Phthalate Exposures: Findings from the National Health and Nutrition Examination Survey, 2001–2010

Background: Phthalates are ubiquitous environmental contaminants. Because of potential adverse effects on human health, butylbenzyl phthalate [BBzP; metabolite, monobenzyl phthalate (MBzP)], di-n-butyl phthalate [DnBP; metabolite, mono-n-butyl phthalate (MnBP)], and di(2-ethylhexyl) phthalate (DEHP) are being replaced by substitutes including other phthalates; however, little is known about consequent trends in population-level exposures.Objective: We examined temporal trends in urinary concentrations of phthalate metabolites in the general U.S. population and whether trends vary by sociodemographic characteristics.Methods: We combined data on 11 phthalate metabolites for 11,071 participants from five cycles of the National Health and Nutrition Examination Survey (2001–2010). Percent changes and least square geometric means (LSGMs) were calculated from multivariate regression models.Results: LSGM concentrations of monoethyl phthalate, MnBP, MBzP, and ΣDEHP metabolites decreased between 2001–2002 and 2009–2010 [percent change (95% CI): –42% (–49, –34); –17% (–23, –9); –32% (–39, –23) and –37% (–46, –26), respectively]. In contrast, LSGM concentrations of monoisobutyl phthalate, mono(3-carboxypropyl) phthalate (MCPP), monocarboxyoctyl phthalate, and monocarboxynonyl phthalate (MCNP) increased over the study period [percent change (95% CI): 206% (178, 236); 25% (8, 45); 149% (102, 207); and 15% (1, 30), respectively]. Trends varied by subpopulations for certain phthalates. For example, LSGM concentrations of ΣDEHP metabolites, MCPP, and MCNP were higher in children than adults, but the gap between groups narrowed over time (p_interaction < 0.01).Conclusions: Exposure of the U.S. population to phthalates has changed in the last decade. Data gaps make it difficult to explain trends, but legislative activity and advocacy campaigns by nongovernmental organizations may play a role in changing trends.Citation: Zota AZ, Calafat AM, Woodruff TJ. 2014. Temporal trends in phthalate exposures: findings from the National Health and Nutrition Examination Survey, 2001–2010. Environ Health Perspect 122:235–241; http://dx.doi.org/10.1289/ehp.1306681     

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001–2010

Objectives. We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States.Methods. We analyzed data from 11 114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults.Results. After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use.Conclusions. Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.A recently published and widely cited report by the Institute of Medicine called for the greater prioritization of research on the health of sexual minorities (i.e., individuals who identify as lesbian, gay, bisexual, or nonheterosexual) in the United States.1 Although this seminal review demonstrated that much progress has been made in documenting sexual minority health disparities and elucidating their determinants, the Institute of Medicine committee noted a number of critical research challenges. For example, most empirical literature that examines sexual minority health has been conducted using convenience samples and local studies. To inform, implement, and achieve coordinated public health responses at the national level, the report recommended increased attention to and investigation of the health of sexual minority populations from nationally representative data.Despite the paucity of population-based sexual minority research, accumulated data from nonprobability samples provide evidence of health disparities between sexual minority and heterosexual populations in the United States. For example, sentinel surveillance data reported by the Centers for Disease Control and Prevention illustrated that the rates of chlamydia, gonorrhea, herpes, and genital warts infections have increased in previous years, with gay, bisexual, and other men who have sex with men experiencing the largest spike in cases.2 Recent data also indicated that human papillomavirus (HPV) infections account for most incident and prevalent sexually transmitted infections (STIs) for both men and women in the United States.3 In addition to the established increased risk of STIs and HIV among sexual minority men,1,4,5 observational studies have also demonstrated higher rates of STIs among women who have sex with women compared with women who have sex with men only.6–8 Notably, gender differences in STIs have also been observed among samples of heterosexual adults. Although most studies suggest that men have a higher incidence of most STIs than women,9,10 1 study found that women were more likely to have herpes simplex virus type 2 (HSV-2) compared with men.11 As such, it stands to reason that there may be important differences in STI rates by both sexual orientation and biological gender.An increased risk of mental health problems, hazardous alcohol use, and illicit drug use among sexual minority populations has also been found in previous research. Studies using probability sampling have documented disparities by sexual minority status in the prevalence of psychiatric disorders,12–15 tobacco use,16 drug use,17 health care access,17,18 violence and victimization,17 and chronic disease risk, including cardiovascular risk, asthma, and obesity.19,20 With few exceptions, a limited number of population-based health studies have explicitly examined variability within sexual minority populations, as many single-state or single-wave population studies lack sufficient sample size to examine differences by key sociodemographics such as gender.17To examine sexual minority health disparities at the national level, we analyzed data from the 2001 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of civilian, noninstitutionalized populations in the United States.21 Given the accumulating evidence for variability in health outcomes within sexual minority populations, we sought to describe trends separately for sexual minority men and sexual minority women compared with their heterosexual counterparts. Specifically, our aims were to utilize the NHANES to (1) investigate the prevalence of 5 of the most commonly reported STIs—gonorrhea, chlamydia, HSV-2, HIV, and HPV (as measured by reports of genital warts)—using a combination of biomarker and self-reported data; (2) assess prevalence of mental health and health behaviors, including number of poor mental health days, smoking, heavy drinking, and illicit drug use; and (3) examine disparities in health indicators between sexual minority men versus heterosexual men and sexual minority women versus heterosexual women.     

Association between Blood Lead and Walking Speed in the National Health and Nutrition Examination Survey (NHANES 1999–2002)

Background: Walking speed is a simple and reliable measure of motor function that is negatively associated with adverse health events in older people, including falls, disability, hospital admissions, and mortality. Lead has adverse affects on human health, particularly on the vascular and neurological systems.Objective: We explored the hypothesis that lead is associated with slower walking speed.Methods: We used U.S. National Health and Nutrition Examination Survey (NHANES) cross-sectional data from 1999–2002. The time to walk 20 ft (walking speed) was measured among 1,795 men and 1,798 women ≥ 50 years of age. The association between walking speed and quintiles of blood lead concentration was estimated separately in men and women using linear regression models adjusted for age, education, ethnicity, alcohol use, smoking status, height, and waist circumference.Results: Mean blood lead concentrations and walking speeds were 2.17 μg/dL and 3.31 ft/sec in women, and 3.18 μg/dL and 3.47 ft/sec in men, respectively. Among women, walking speed decreased with increasing quintiles of blood lead, resulting in an estimated mean value that was 0.11 ft/sec slower (95% CI: –0.19, –0.04; p-trend = 0.005) for women with blood lead concentrations in the highest versus lowest quintile. In contrast, lead was not associated with walking speed in men.Conclusion: Blood lead concentration was associated with decreased walking speed in women, but not in men. Our results contribute to the growing evidence that lead exposure, even at low levels, is detrimental to public health.     

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.     

Family Consumer Behaviors,Adolescent Prediabetes and Diabetes in the National Health and Nutrition Examination Survey (2007–2010)

Background: Prediabetes or diabetes (characterized by hemoglobin A1c [HbA1c] levels ≥ 5.7 gm%) has been associated with numerous long-term complications. Family consumer behaviors are important risk factors that lead to impaired glucose tolerance or diabetes. However, few studies have studied the association between the family consumer environment and prediabetes and diabetes in adolescents.

Objective: The aim of this study was to examine the association between family consumer behaviors (healthy food availability and supermarket spending) and adolescent prediabetes and diabetes (ClinicalTrials.gov identifier #NCT03136289.)

Methods: Data from a nationwide survey conducted by the Centers for Disease Control and Prevention (National Health and Nutrition Examination Survey [NHANES] 2007–2010 data) were used for these analyses. Adolescents aged 12–19 years were selected for this study. Bivariate analyses and logistic regression models assessed the relationship between family consumer behaviors and the prevalence of adolescent prediabetes and diabetes. Multivariable models adjusted for age, gender, ethnicity, physical activity, education, income, and household size.

Results: A total of 2520 adolescents were eligible for this study. Adolescents with healthier household food availability had negative odds (odds ratio [OR] = 0.74, 95% confidence interval [CI], 0.55–1.00), as did higher log supermarket spending (OR = 0.69; 95% CI, 0.57–0.85). Interaction models demonstrated that adolescent females had more negative odds of prediabetes/diabetes for both healthier food availability (OR = 0.79, 95% CI, 0.39–1.29) and for greater log supermarket spending (OR = 0.69, 95% CI, 0.57–0.85).

Conclusion: This study shows that both healthy food availability and an increase in supermarket spending were associated with a decreased adjusted prevalence of prediabetes and diabetes in adolescents, with a greater effect in females. These results suggest the need for policy and dietary interventions targeting the consumer environment.     

Associations Between Selected Xenobiotics and Antinuclear Antibodies in the National Health and Nutrition Examination Survey, 1999–2004

Background:

Potential associations between background environmental chemical exposures and autoimmunity are understudied.

Objectives:

Our exploratory study investigated exposure to individual environmental chemicals and selected mixtures in relation to the presence of antinuclear antibodies (ANA), a widely used biomarker of autoimmunity, in a representative sample of the U.S. population.

Methods:

This cross-sectional analysis used data on 4,340 participants from the National Health and Nutrition Examination Survey (1999–2004), of whom 14% were ANA positive, to explore associations between ANA and concentrations of dioxins, dibenzofurans, polychlorinated biphenyls, organochlorines, organophosphates, phenols, metals, and other environmental exposures and metabolites measured in participants’ serum, whole blood, or urine. For dioxin-like compounds with toxic equivalency factors, we developed and applied a new statistical approach to study selected mixtures. Lognormal models and censored-data methods produced estimates of chemical associations with ANA in males, nulliparous females, and parous females; these estimates were adjusted for confounders and accommodated concentrations below detectable levels.

Results:

Several associations between chemical concentration and ANA positivity were observed, but only the association in males exposed to triclosan remained statistically significant after correcting for multiple comparisons (mean concentration ratio = 2.8; 95% CI: 1.8, 4.5; p < 0.00001).

Conclusions:

These data suggest that background levels of most xenobiotic exposures typical in the U.S. population are not strongly associated with ANA. Future studies should ideally reduce exposure misclassification by including prospective measurement of the chemicals of concern and should track changes in ANA and other autoantibodies over time.

Citation:

Dinse GE, Jusko TA, Whitt IZ, Co CA, Parks CG, Satoh M, Chan EKL, Rose KM, Walker NJ, Birnbaum LS, Zeldin DC, Weinberg CR, Miller FW. 2016. Associations between selected xenobiotics and antinuclear antibodies in the National Health and Nutrition Examination Survey, 1999–2004. Environ Health Perspect 124:426–436; http://dx.doi.org/10.1289/ehp.1409345     

Prevalence of and Factors Associated with Sarcopenia in Korean Cancer Survivors: Based on Data Obtained by the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2011

Using a representative dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we analyzed anthropometric and dual-energy X-ray absorptiometry (DXA)-determined body composition findings for 493 cancer survivors (mean age a61.1 ± 12.6 years; 35.7% male). A much higher proportion of men (30.1%) than women (0.6%) met the criteria of sarcopenia. Subjects with a history of lung cancer, genitourinary cancer, or gastric cancer were prone to develop sarcopenia (31.6%, 26.3%, and 21.4%, respectively). Furthermore, sarcopenia was more prevalent among elderly (≥65 years; P < 0.001), those with a lower BMI level (<23 kg/m²; P < 0.001), heavy drinker (P = 0.012), or smoker (P < 0.001), and those with inadequate intakes of protein (P = 0.017) and vitamin A (P = 0.024). Multivariable logistic analyses revealed sarcopenia was significantly associated with male gender (odds ratio [OR], 68.14; 95% CI, 15.52–299.13), a BMI of <23 kg/m² (OR 35.93, 95% CI, 8.24–156.67), and inadequate protein intake (OR 3.07, 95% CI, 1.30–7.22); these factors are significant predictors of sarcopenia in Korean cancer survivors.     

Relationship between blood cadmium,lead, and serum thyroid measures in US adults – the National Health and Nutrition Examination Survey (NHANES) 2007–2010

Experimental studies have shown that both cadmium (Cd) and lead have potent endocrine disrupting activity. However, studies on whether these heavy metals disrupt thyroid system in humans, especially in general populations with low levels of exposure, are sparse. The study analyzed 6,231 participants aged 20 and older with measurements from 2007–2010 of the National Health and Nutrition Examination Survey (NHANES) to investigate whether whole blood Cd and lead level are associated with serum thyroid hormones measures. Our study suggests that thyroid function may be disrupted by both Cd and lead exposures in the general population and the specific roles of Cd and lead exposure on thyroid axis may differ by sex. However, the mechanisms by which these heavy metals may disrupt thyroid system function in general population needs to be further investigated.     

Food Sources of Energy and Nutrients among Children in the United States: National Health and Nutrition Examination Survey 2003–2006

Background: Recent detailed analyses of data on dietary sources of energy and nutrients in US children are lacking. The objective of this study was to identify food sources of energy and 28 nutrients for children in the United States. Methods: Analyses of food sources were conducted using a single 24-h recall collected from children 2 to 18 years old (n = 7332) in the 2003–2006 National Health and Nutrition Examination Survey. Sources of nutrients contained in foods were determined using nutrient composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from the total diet and from each food group were adjusted for the sample design using appropriate weights. Percentages of the total dietary intake that food sources contributed were tabulated by rank order. Results: The two top ranked food/food group sources of energy and nutrients were: energy—milk (7% of energy) and cake/cookies/quick bread/pastry/pie (7%); protein—milk (13.2%) and poultry (12.8%); total carbohydrate—soft drinks/soda (10.5%) and yeast bread/rolls (9.1%); total sugars—soft drinks/soda (19.2%) and yeast breads and rolls (12.7%); added sugars—soft drinks/soda (29.7%) and candy/sugar/sugary foods (18.6%); dietary fiber—fruit (10.4%) and yeast bread/rolls (10.3%); total fat—cheese (9.3%) and crackers/popcorn/pretzels/chips (8.4%); saturated fatty acids—cheese (16.3%) and milk (13.3%); cholesterol—eggs (24.2%) and poultry (13.2%); vitamin D—milk (60.4%) and milk drinks (8.3%); calcium—milk (33.2%) and cheese (19.4%); potassium—milk (18.8%) and fruit juice (8.0%); and sodium—salt (18.5%) and yeast bread and rolls (8.4%). Conclusions: Results suggest that many foods/food groupings consumed by children were energy dense, nutrient poor. Awareness of dietary sources of energy and nutrients can help health professionals design effective strategies to reduce energy consumption and increase the nutrient density of children’s diets.