Asthma Incidence: Data from the National Health Interview Survey, 1980–1996

Objective. To obtain historical estimates of US asthma incidence from 17 years of health survey data. Methods. The 1980 through 1996 National Health Interview Survey contained a question asking about the time of asthma onset in persons with asthma. Annual past year incidence estimates were calculated from self-reports of asthma status. Results. Incidence increased from 2.5 per 1,000 (SE 0.37) in 1980 to 6.0 per 1,000 (SE 0.75) in 1996. Incidence increased faster in children than in adults and increased in females but not in males during this time. Conclusion. These findings suggest that increasing asthma incidence contributed to the increasing prevalence during this time.     

Racial and Ethnic Disparities in Current Asthma and Emergency Department Visits: Findings from the National Health Interview Survey, 2001–2010

Objectives. Racial/ethnic disparities in current asthma prevalence and medical care are a major public health concern. We examined the differences in asthma prevalence and morbidity among major racial/ethnic populations in the US. Methods. We analyzed data from the 2001–2010 National Health Interview Survey for adults (≥18 years) and children and adolescents (<18 years). Outcome variables were current asthma prevalence, at least one attack in the past 12 months, and at least one asthma-related emergency department/urgent care center (ED/UCC) visit in the past 12 months. We used multivariate logistic regression to calculate the model-adjusted prevalence and risk ratios (ARR). Results. In our study, 9.0% of the children and 7.2% of the adults had current asthma. Non-Hispanic black and Puerto Rican children were more likely to have current asthma (ARR 1.46, 1.66, respectively) and to visit the ED/UCC (ARR 1.61, 1.67, respectively) than non-Hispanic whites. American Indian/Alaskan Native children were more likely to have current asthma (ARR 1.76) than non-Hispanic whites. Mexican/Mexican American children and adults had lower prevalence of current asthma but higher ED/UCC use (adults only) than non-Hispanic whites. Among adults, Puerto Ricans and American Indian/Alaskan Natives were more likely to have current asthma (ARR 1.60, 1.39, respectively) than non-Hispanic whites, and all the studied racial/ethnic groups except Asians were more likely to have visited the ED/UCC than non-Hispanic whites. Adults and children who received emergency care for asthma in the past 12 months more frequently received multiple components of asthma management and control (e.g., taking long-term medication, having an asthma management plan) compared to those without emergency care. Conclusions. Racial/ethnic differences in current asthma prevalence, asthma attacks, and increased utilization of emergency room visits for asthma among minorities persist among children and adults. Appropriate and effective asthma management and education may lead to better asthma control and reduce emergency care utilization.     

National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012

BACKGROUND

There are few current population-based estimates of the patterns of diabetes screening in the United States. The American Diabetes Association (ADA) recommends universal screening of adults ≥ 45 years, and high-risk adults < 45 years, but there is no current assessment of ADA guideline performance in detecting diabetes and prediabetes. Furthermore, data on racial/ethnic patterns of screening are limited.

OBJECTIVE

Our aim was to estimate diabetes screening prevalence for the US adult population and specifically for those who meet ADA criteria; to report the prevalence of prediabetes and diabetes among these groups; and to determine if high-risk race/ethnicity was associated with reported screening.

DESIGN

This was a Cross-sectional survey.

PARTICIPANTS

Non-pregnant adults (≥ 21 years) without diabetes or prediabetes who participated in the National Health and Nutrition Examination Survey (NHANES) in 2005–2012 (n = 17,572) were included in the study. “Screening-recommended” participants, classified by ADA criteria, included (1) adults ≥ 45 years and (2) “high-risk” adults < 45 years. “Screening-not-recommended” participants were adults < 45 years who did not meet criteria.

MAIN MEASURES

Diabetes screening status was obtained by self-report. We used calibrated HbA_1c and/or fasting glucose levels to define undiagnosed diabetes and prediabetes.

KEY RESULTS

Seventy-six percent of the study population (approximately 136 million US adults) met ADA criteria. Among them, less than half (46.2 %) reported screening; undiagnosed diabetes affected 3.7 % (5 million individuals), and undiagnosed prediabetes affected 36.3 % (49 million people.) African Americans were more likely to report screening, both among adults ≥ 45 years and among “high risk” younger adults (OR 1.27 and 1.36, respectively.) Hispanic participants were also more likely to report screening (OR 1.31 for older adults, 1.42 for younger adults.) The screening rate among “screening-not-recommended” adults was 29.6 %; the prevalence of diabetes and prediabetes were 0.4 and 10.2 %, respectively.

CONCLUSIONS

In a nationally representative sample, 76 % of adults met ADA screening criteria, of whom fewer than half reported screening. Limitations include cross-sectional design and screening self-report.KEY WORDS: diabetes screening, prediabetes, NHANES, ADA, disparities     

Prevalence of Asthma among Adult Females and Males in the United States: Results from the National Health and Nutrition Examination Survey (NHANES), 2001–2004

Background. The prevalence of asthma has increased over the last three decades with females exhibiting a higher prevalence of asthma than males. The objective of this study was to obtain gender-specific estimates of the prevalence of current and ever asthma and describe the relationships between risk factors and asthma by gender in US men and women ages 20 to 85. Methods. Data for this study came from two cycles (2001–2002 and 2003–2004) of National Health and Nutrition Examination Survey (NHANES) and included 9,243 eligible adults: 4,589 females and 4,654 males. Multiple logistic regression was used to investigate gender-specific associations between race/ethnicity, body mass index (BMI), sociodemographic characteristics, and smoking habits for current asthma and ever asthma. Results. The prevalence of current asthma was 8.8% for women and 5.8% for men, while the prevalence of ever having been diagnosed with asthma was higher (13.7% and 10.4% for women and men, respectively). Current asthma was less prevalent in Mexican American women (1.9%) and men (0.9%) born in Mexico as compared to Mexican Americans born in the U.S. (8.7% and 5.2% for women and men, respectively) or for any other ethnic group. Approximately 20% of extremely obese women and men had ever been diagnosed with asthma; among this group, 15% reported they had current asthma. Results from multiple logistic regression models indicate that extreme obesity and living in poverty were strongly associated with current and ever asthma for both women and men, as was former smoking and ever asthma for men. Conclusion. As compared to previous NHANES reports, our results indicate that the prevalence of asthma among U.S. adults continues to increase. Further, our findings of marked differences among subgroups of the population suggest asthma-related disparities for impoverished persons and greater prevalence of asthma among obese and extremely obese US adults.     

Sarcopenia is associated with Framingham risk score in the Korean population: Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2011

Background Sarcopenia is a risk factor for metabolic disorders and cardiovascular disease, but the association between sarcopenia and cardiovascular risk factors according to age and obesity status in the general population remains unknown. We thus investigated these associations in the Korean population. Methods We included 8,958 and 8,518 subjects from the fifth Korean National Health and Nutrition Examination Survey (KNHANES) (from 2010 and 2011, respectively). The study was restricted to participants ≥ 20 years old who had completed the health examination survey, including whole body dual-energy X-ray absorptiometry scans. After exclusion, 7,366 subjects (3,188 men, 4,178 women) were included in our final analysis. Age was categorized according to three age groups (20–39, 40–59, and ≥ 60 years), and subjects were categorized according to their sarcopenic and obesity status. Cardiovascular risk was assessed with Framingham risk score (FRS). Results The sarcopenic obese group had a higher FRS than the non-sarcopenic obese group, which had a higher FRS than the non-sarcopenic non-obese group. Age-wise, the 20–39 year-old group showed a non-significant association between sarcopenia and FRS. In the 40–59 year-old group, regardless of obesity status, sarcopenic subjects had a higher FRS than non-sarcopenic subjects. In the ≥ 60 year-old group, sarcopenic subjects had a higher FRS than non-sarcopenic subjects for the non-obese group. Conclusions Sarcopenia was associated with cardiovascular disease and may be an early predictor of its susceptibility in both elderly and middle-aged subjects. Thus, management of sarcopenia is necessary to prevent cardiovascular disease.     

Association of Urinary Bisphenol A Concentration with Allergic Asthma: Results from the National Health and Nutrition Examination Survey 2005–2006

Objective. Bisphenol A (BPA) is being increasingly associated with adverse health effects. Our objective was to determine whether urinary BPA concentration is associated with allergic asthma in a representative US population. Methods. Data for this analysis were obtained from the National Health and Nutrition Examination Survey 2005–2006 survey and included asthma-related questions, total immunoglobulin E (IgE), 19 allergen-specific IgE levels, and urinary environmental phenol measurements. Allergic asthma was defined as a history of asthma ever, high eosinophil count, and high total IgE or atopy. Association analyses included dichotomous and polychotomous logistic regression, receiver operating characteristic curves, Akaike information criterion, and likelihood ratio χ². Results. We found that 10-fold increase in BPA was independently associated with a higher likelihood of allergic asthma in females [odds ratio (OR) = 2.21, p = .032] but not in males (OR = 0.83, p = .474). These findings were reaffirmed when allergic asthma was defined based on atopy rather than total IgE (OR = 2.45, p = .001 in females and OR = 0.83, p = .605 in males). Urinary BPA was significantly associated with sensitization to various specific allergens in a dose–response manner. Lastly, urinary BPA independently predicted an asthma episode in the past 12 months in females but not in males. Conclusions. Urinary BPA is significantly associated with allergic asthma in females.     

Age at type 2 diabetes onset and glycaemic control: results from the National Health and Nutrition Examination Survey (NHANES) 2005–2010

Aims/hypothesis

We tested the hypothesis that age younger than 65 years at type 2 diabetes diagnosis is associated with worse subsequent glycaemic control.

Methods

A cross-sectional analysis of data from participants in the 2005–2010 National Health and Nutrition Examination Survey was performed. For adults with self-reported diabetes, we dichotomised age at diabetes diagnosis as younger (<65 years) vs older (≥65 years). The primary outcome of interest was HbA_1c >9.0% (75 mmol/mol). Secondary outcomes were HbA_1c >8.0% (64 mmol/mol) and >7.0% (53 mmol/mol). We used multivariable logistic regression for analysis.

Results

Among 1,438 adults with diabetes, a higher proportion of those <65 years at diagnosis compared with those ≥65 at diagnosis had an HbA_1c >9.0% (14.4% vs 2.5%, p?<?0.001). After adjustment for sex, race/ethnicity, education, income, insurance, usual source of care, hyperglycaemia medication, duration of diabetes, family history, BMI and waist circumference, age <65 years at diagnosis remained significantly associated with greater odds of HbA_1c >9.0% (OR 3.22, 95% CI 1.54, 6.72), HbA_1c >8.0% (OR 2.72, 95% CI 1.43, 5.16) and HbA_1c >7.0% (OR 1.92, 95% CI 1.18, 3.11). The younger group reported fewer comorbidities, but were less likely to report good health (OR 0.54, 95% CI 0.36, 0.83).

Conclusions/interpretation

Younger age at type 2 diabetes diagnosis is significantly associated with worse subsequent glycaemic control. Because patients who are younger at diagnosis have fewer competing comorbidities and complications, safe, aggressive, individualised treatment could benefit this higher-risk group.     

Iron Indices in Chronic Kidney Disease in the National Health and Nutritional Examination Survey 1988–2004

Background and objectives: Anemia is a common and early complication of nondialysis chronic kidney disease (CKD). One contributing factor is iron deficiency, which may be particularly problematic during erythropoietin replacement therapy. The aim of this study was to examine the prevalence of iron deficiency in nondialysis CKD.Design, setting, participants, & measurements: The National Health and Nutritional Examination Survey (NHANES) data for NHANES III (1988 to 1994) and subsequent NHANES 2-yr datasets, 1999 to 2000, 2001 to 2002, and 2003 to 2004 were analyzed for individuals >18 yr old.Results: It was found that low levels of iron tests [either serum ferritin < 100 ng/ml or transferrin saturation (TSAT) < 20%] were present in most patients with reduced creatinine clearance (CrCl). The percentage of low iron tests was higher among women than men, present in 57.8 to 58.8% of men and 69.9 to 72.8% of women (P < 0.001). With declining levels of CrCl, in women, TSAT levels decreased, whereas, surprisingly, serum ferritin tended to progressively increase. The percentage of anemic subjects increased progressively with declining quartiles of TSAT but was unrelated to serum ferritin quartiles.Conclusions: It was found that low levels of iron tests, following National Kidney Foundation/Kidney Disease Outcomes Quality Initiative guidelines (either serum ferritin < 100 ng/ml or TSAT < 20%) were present in most patients with reduced CrCl.Little is known regarding iron status among patients with chronic kidney disease (CKD), except for those with stage 5 disease on hemodialysis. In hemodialysis, iron deficiency is a common problem that hinders the effectiveness of erythropoietin treatment (1). Iron deficiency in hemodialysis results primarily from excessive blood loss due to dialysis filter and line blood retention, frequent blood testing, access bleeding, and surgical blood loss (2). Most of these factors are not present, or present to a lesser degree in earlier stages of CKD. Therefore, it is unclear whether iron deficiency is as frequent a problem in these patients. The population of patients with nondialysis CKD is particularly important, however, in that it is much larger than that of hemodialysis (3). Furthermore, anemia develops relatively early in CKD (4), becoming an important cause of fatigue and other symptoms that diminish quality of life.The National Kidney Foundation''s Kidney Disease Outcome Quality Initiative (KDOQI) anemia guidelines recommend that during erythropoiesis-stimulating agent (ESA) treatment in nondialysis CKD that serum ferritin and transferrin saturation (TSAT) be maintained >100 ng/ml and 20%, respectively (5). Because of the lack of published data on this subject, it is not currently possible to determine what proportion of patients with nondialysis CKD have iron values below these threshold levels. For patients not undergoing ESA treatment, the KDOQI guidelines make no recommendations as to levels of iron tests that indicate sufficiency or deficiency.Because serum ferritin and TSAT are the most commonly used tests to assess iron status in CKD, it would be useful to know mean test results and prevalence of decreased levels at different stages of CKD. A helpful source of information in this regard is the National Health and Nutritional Examination Survey (NHANES). This community-based survey includes test results for a sample of individuals representative of the general U.S. population. Hsu et al. studied the NHANES III database as part of an analysis of anemia in CKD (4). The authors found low iron indices to be frequently present at all levels of reduced creatinine clearance (CrCl). The analysis, however, was limited in scope because most data were collected before the widespread use of ESA or the publication of the first KDOQI guidelines. The purpose of the analysis presented here was to fully examine the distribution of serum ferritin and TSAT among individuals with CKD studied by the NHANES program.     

Age and glycemic control among adults with type 2 diabetes in the United States: An assessment from the National Health and Nutrition Examination Survey (NHANES) 2013–2014

AimTo assess the age and its association with glycemic control (GC) among adults with type 2-diabetes in the United States.Materials and materialsData were collected from the National Nutrition Examination Survey (NHANES) 2013–2014 (n = 697), cross-sectional national survey adults with Type2 diabetes. Characteristics included retinopathy diagnosis, blood pressure, albumin-creatinine ratio, hemoglobin A1c (HbA1c), BMI, cholesterol, smoking status, pills/insulin, exercise, age, age at diagnosis, education, sex, race, and marital status. Diabetes preventive behaviors were included. Predictors of GC were assessed using logistic regression.ResultsThe mean age was 61 (SD ±13); the average age at diagnosis 50 (SD ±12.9) and women (51%). Age ≥60, diabetes length >10yrs, taking pills/on insulin, albumin-creatinine ratio ≤30mg/g, optimal BP, no retinopathy diagnosis, optimal cholesterol, seeing a doctor for diabetes, doctors checkup ≥2 times and checking HbA1c annually were significant predictors of GC. The association between GC and age (OR=.97, p<.001; CI: .96-.98) diabetes length >10yrs (OR=1.55, p<.05; CI: 1.02-2.34), creatinine-albumin ratio ≤30mg/g (OR=1.97, p<.001; CI: 1.32-2.94) and checking HbA1c annually (OR=1.86, p<.01; CI: 1.16-3.00) remained significant after adjustment for the effects of all other statistically significant covariates.ConclusionsGC was prevalent among older individuals; suggestive of intervention programs for young adults with diabetes and continuous HbA1c assessment at least annually.     

Food Insecurity is Associated with Diabetes Mellitus: Results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002

BACKGROUND Food insecurity refers to limited or uncertain access to food resulting from inadequate financial resources. There is a clear association between food insecurity and obesity among women, but little is known about the relationship between food insecurity and type 2 diabetes. OBJECTIVE To evaluate whether there is an independent association between food insecurity and diabetes. DESIGN Cross-sectional analysis of the nationally representative, population-based National Health and Nutrition Examination Survey (1999–2002 waves). PARTICIPANTS Four thousand four hundred twenty-three adults >20 years of age with household incomes ≤300% of the federal poverty level. MEASUREMENTS We categorized respondents as food secure, mildly food insecure, or severely food insecure using a well-validated food insecurity scale. Diabetes was determined by self-report or a fasting serum glucose ≥126 mg/dl. RESULTS Diabetes prevalence in the food secure, mildly food insecure, and severely food insecure categories was 11.7%, 10.0%, and 16.1%. After adjusting for sociodemographic factors and physical activity level, participants with severe food insecurity were more likely to have diabetes than those without food insecurity (adjusted odds ratio [AOR] 2.1, 95% CI 1.1–4.0, p = .02). This association persisted after further adjusting for body mass index (AOR 2.2, 95% CI 1.2–3.9, p = .01). CONCLUSIONS Food insecurity may act as a risk factor for diabetes. Among adults with food insecurity, increased consumption of inexpensive food alternatives, which are often calorically dense and nutritionally poor, may play a role in this relationship. Future work should address how primary care clinicians can most effectively assist patients with food insecurity to make healthy dietary changes. Portions of this work were presented in abstract form at the 2006 Society of General Medicine meeting.     

Prognostic value of resting heart rate in predicting undiagnosed diabetes in adults: Korean National Health and Nutrition Examination Survey 2008–2018

Background and aimAlthough resting heart rate (RHR) is associated with prevalence and incidence of diabetes, whether it is associated with undiagnosed diabetes is still unclear. We aimed to investigate whether the RHR is associated with the prevalence of undiagnosed diabetes in a large Korean national dataset.Methods and resultsThe Korean National Health and Nutrition Examination Survey data from 2008 to 2018 were used. After screening, 51,637 participants were included in this study. The odds ratios and 95% confidence intervals (CIs) for undiagnosed diabetes were calculated using multivariable-adjusted logistic regression analyses.Analyses showed that participants with a RHR of ≥90 bpm showed a 4.00- (95% CI: 2.77–5.77) and 3.21-times (95% CI: 2.01–5.14) higher prevalence of undiagnosed diabetes for men and women, respectively, than those with a RHR of <60 bpm. The linear dose-response analyses showed that each 10-bpm increment in RHR was associated with a 1.39- (95% CI: 1.32–1.48) and 1.28-times (95% CI: 1.19–1.37) higher prevalence of undiagnosed diabetes for men and women, respectively. In the stratified analyses, the positive association between RHR and the prevalence of undiagnosed diabetes was tended to be stronger among those who were younger (age: <40 years) and lean (BMI: <23 kg/m²).ConclusionsElevated RHR was significantly associated with a higher prevalence of undiagnosed diabetes in Korean men and women, independent of demographic, lifestyle, and medical factors. Accordingly, the value of RHR as a clinical indicator and health marker, especially in reducing the prevalence of undiagnosed diabetes, is suggestible.     

Association of Childhood Obesity With Atopic and Nonatopic Asthma: Results From the National Health and Nutrition Examination Survey 1999–2006

Background. Obesity and asthma prevalence have both risen among children over the last several decades, and research efforts increasingly suggest that obesity is associated with asthma. Some, but not all, studies have shown that the effect of obesity on asthma is stronger among nonatopic individuals than among those with atopy. Systemic inflammation may be a factor in this relationship. Objective. To examine the association of obesity with atopic and nonatopic asthma among U.S. children and to assess the role of C-reactive protein. Design. Nationally representative data from the National Health and Nutrition Examination Survey (NHANES) were used to examine the relationship of weight to current asthma using logistic regression. Overweight was defined as ≥85th percentile of body mass index (BMI)-for-age and obesity was defined as ≥95th percentile of BMI-for-age. The presence of at least one positive allergen-specific immunoglobulin E (IgE) was used to stratify the relationship by atopic status in 2005–2006 data (n = 3387). Setting and Participants. Stratified, multistage probability sampling was used to identify survey participants. This analysis includes children ages 2–19 (n = 16,074) from the 1999–2006 NHANES who have information on BMI and current asthma. Main Outcome Measure. Self-report of doctor-diagnosed current asthma. Results. Obesity was significantly related to current asthma among children and adolescents (odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.33, 2.12). The association was stronger in nonatopic children (OR: 2.46, 95% CI: 1.21, 5.02) than in atopic children (OR: 1.34, 95% CI: 0.70, 2.57) (interaction p value = .09). C-reactive protein levels were associated with current asthma in nonatopic children, but not after adjusting for BMI. Conclusion. Excess weight in children is associated with higher rates of asthma, especially asthma that is not accompanied by allergic disease.     

Association Between Hearing Impairment and Albuminuria in the Korean Adults: The 2011–2012 Korea National Health and Nutrition Examination Survey

Although the associations between albuminuria and renal and cardiovascular diseases, including diabetes and hypertension, have been extensively studied, few studies have investigated the association between albuminuria and hearing impairment. In this study, we assessed the relationship between albuminuria and hearing impairment in 9786 adult Korean subjects, using data from the Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2011–2012. The range of urinary albumin-to-creatinine ratio (UACR) was divided into 4 grades: grade 1 (first tertile of low-grade albuminuria [LGA]), 0.00 to 1.99 mg/g Cr; grade 2 (second tertile of LGA), 2.00 to 5.49 mg/g Cr; grade 3 (third tertile of LGA), 5.50 to 29.99 mg/g Cr; grade 4 (albuminuria), ≥30.00 mg/g Cr.The age- and sex-adjusted weighted UACR was higher in subjects with hearing impairment compared with those without hearing impairment (26.2 ± 4.7 mg/g Cr vs 14.1 ± 1.5 mg/g Cr, P = 0.020). The age- and sex-adjusted weighted prevalence of albuminuria was also higher in subjects with hearing impairment compared with subjects without hearing impairment. (8.3 ± 0.9% vs 5.8 ± 0.4%, P = 0.013) The age- and sex-adjusted weighted percentage of hearing impairment increased as UACR increased (18.0% ± 0.6%, 20.0% ± 0.8%, 22.2% ± 0.9%, 25.3% ± 2.0%, respectively; P < 0.001). Logistic regression analyses were performed for hearing impairment by albuminuria, with age, sex, tobacco use, heavy alcohol use, educational background, occupational noise exposure, obesity, hypertension, diabetes, total serum cholesterol, and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² as covariates. Using grade 1 of UACR as the control, grade 3 (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05–1.53, P = 0.005) and grade 4 (OR 1.41, 95% CI 1.04–1.90, P = 0.026) of UACR were correlated with hearing impairment, respectively. When the level of hearing impairment (dB) was analyzed as a continuous variable, it was positively correlated with log UACR (Spearman correlation, unadjusted r = 0.226, adjusted r = 0.076, P < 0.001).In conclusion, we are the first to demonstrate that albuminuria is associated with hearing impairment in the Korean general population, using nationally representative data. Screening for albuminuria would allow for interventions for the prevention of hearing impairment.     

10-year risk for atherosclerotic cardiovascular disease and coronary heart disease among Korean adults: Findings from the Korean National Health and Nutrition Examination Survey 2009–2010

Background

This study examined the distribution of the 10-year risk for development of atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD), and the proportion of participants eligible for lipid management, in the Korean population.

Methods

The risk was estimated using the Pooled Cohort Equations for non-Hispanic Whites and the Adult Treatment Panel (ATP) III equations. Eligibility for lipid-lowering treatment was assessed using the American College of Cardiology/American Heart Association Blood Cholesterol Guideline and the ATP III recommendation. Complex sampling design and area under the receiver operator characteristic curve (AUC) were used.

Results

Among 7594 ASCVD-free Korean adults, aged 40–79 years, 31.3% (men, 44.1%; women, 19%) had a 10-year risk for an ASCVD event of ≥ 7.5%, and 27.1% (men, 39.4%; women, 15.2%) had a 10-year risk for a CHD event of ≥ 10%. These proportions differed according to age groups, ranging from 6.1 to 91.9% and 8.7 to 58.7% for patients in their 40s–70s, using the ASCVD and CHD risk estimations, respectively. Overall, 78.7% of individuals remain in the same risk stratum. Those eligible for lipid management included 32.8% of the participants using the ACC/AHA Guideline and 11.9% of those using the ATP III recommendation. In discriminating ASCVD, AUCs for the ASCVD risk assessment method and the CHD risk assessment method were 0.70 and 0.64, respectively (P < 0.001).

Conclusions

The distribution of 10-year ASCVD and CHD risk was different according to the risk assessment methods.     

The relationship between bone mineral density and blood pressure in the Korean elderly population: the Korea National Health and Nutrition Examination Survey, 2008–2011

Abstract

It is not clear whether the inverse relationship between bone mineral density (BMD) and blood pressure (BP) could be generalizable to the general elderly population. We used data from the fourth and fifth Korea National Health and Nutrition Examination Survey. The study sample consisted of 8439 men and postmenopausal women aged 50 years and older. We evaluated the relationship between BMD and BP. When adjusted for covariates, femur neck T-score [coefficient?=??0.391, 95% confidence interval (CI) ?0.766 to ?0.016, p?=?0.041] had an inverse relationship with diastolic BP (DBP), whereas lumbar spine BMD (coefficient?=?0.395, 95% CI 0.058–7.752, p?=?0.047) and T-score (coefficient?=?0.458, 95% CI 0.005–0.911, p?=?0.047) had a positive relationship with systolic BP (SBP). When adjusted for confounding factors, SBP (128.67?±?0.979?mmHg versus 126.36?±?0.545?mmHg, p?=?0.026) and DBP (78.8?±?0.622?mmHg versus 77.27?±?0.283?mmHg, p?=?0.016) were significantly higher in femur neck osteoporosis subjects than non-osteoporosis subjects. However, there were no differences in BP in relation to lumbar spine osteoporosis. Femur neck osteoporosis (odds ratio?=?1.422, 95% CI 1.107–1.827, p?=?0.006) had a significant and positive relationship with hypertension, whereas the other parameters of BMD were not significantly related to hypertension. In conclusion, higher BP and hypertension were significantly and positively correlated with femur neck osteoporosis in men and postmenopausal women aged 50 years and older.     

Vitamin D Status and the Risk of Anemia in Community-Dwelling Adults: Results from the National Health and Nutrition Examination Survey 2001–2006

Low vitamin D status has been implicated in several chronic medical conditions and unfavorable health outcomes. Our goal was to investigate whether serum 25-hydroxyvitamin D (25OHD) levels are a potentially modifiable risk factor for anemia in a nationally representative cohort of community-dwelling individuals in the United States.We performed a cross-sectional study of 5456 individuals (≥17 years) from the National Health and Nutrition Examination Survey from 2001 to 2006. Locally weighted scatterplot smoothing (LOWESS) was used to graphically depict the relationship between serum 25OHD levels and the cumulative frequency of anemia. Multivariable logistic regression models were then used to assess the independent association of 25OHD levels with anemia, while controlling for age, sex, race, body mass index, chronic kidney disease, as well as serum levels of C-reactive protein, ferritin, iron, vitamin B12, and folic acid.The mean (standard error) 25OHD and hemoglobin levels in the analytic group were 23.5 (0.4) ng/mL and 14.4 (0.1) g/dL, respectively. Prevalence of anemia was 3.9%. Locally weighted scatterplot smoothing analysis demonstrated a near-linear relationship between vitamin D status and cumulative frequency of anemia up to 25OHD levels of approximately 20 ng/mL. With increasing 25OHD levels, the curve flattened out progressively. Multivariable regression analysis demonstrated an inverse association of 25OHD levels with the risk of anemia (adjusted odds ratio 0.97; 95% confidence interval 0.95–0.99 per 1 ng/mL change in 25OHD). Compared to individuals with ≥20 ng/mL, individuals with 25OHD levels <20 ng/mL were more likely to be anemic (adjusted odds ratio 1.64; 95% confidence interval 1.08–2.49).In a nationally representative sample of community-dwelling individuals in the United States, low 25OHD levels were associated with increased risk of anemia. Randomized controlled trials are needed to determine whether optimizing vitamin D status can reduce the burden of anemia in the general population.     

Trends in the prevalence of major cardiovascular disease risk factors among Korean adults: Results from the Korea National Health and Nutrition Examination Survey, 1998–2012

Background

Mortality from coronary heart disease in Korea has increased continuously, but there are few comprehensive national data on trend in the prevalence of risk factors for cardiovascular disease in this population. We examined the trends in the prevalence of major risk factors for cardiovascular disease, including smoking, obesity, hypertension, diabetes, and hypercholesterolemia, from 1998 through 2012 in a representative Korean population.

Methods

Using data from the Korea National Health and Nutrition Examination Survey I (1998) to V (2010–2012), we selected the adults aged ≥ 30 yr who participated in both a health examination and health interview survey.

Results

From 1998 to 2012, significant decrease in the prevalence of hypertension was observed in both men (32.5 to 31.5%) and women (26.9 to 24.3%). Smoking rates decreased only in men (65.1 to 47.0%), whereas the prevalence of diabetes did not change over time. Conversely, the prevalence of hypercholesterolemia significantly increased from 7.2% to 12.6% for men and from 8.4% to 14.9% for women, whereas the rates of awareness and treatment for hypercholesterolemia were relatively lower than that of hypertension and diabetes. During the period, prevalence of obesity significantly increased from 26.8% to 38.1% only in men.

Conclusions

The increased prevalence of hypercholesterolemia and obesity may have contributed to the increasing trend in the mortality from coronary heart disease in Korea. Further population-based surveillance of blood cholesterol levels and obesity needs to be performed, and national strategies for improvement of these factors should be established in Korea.