Buyun Liu

Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016

Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016 Autism spectrum disorder (ASD) is a serious neurodevelopmental disorder resulting in a substantial burden for individuals, families, and society.1 Previous surveys have reported a steady increase in ASD prevalence in US children over the past 2 decades.2-4 However, the most recent estimate from the Autism and Developmental Disabilities Monitoring (ADDM) Network for the first time reported a plateau in ASD prevalence (1.46%) in 2012, after documenting a continuous increase from 0.67% in 2000 to 1.47% in 2010.2 In this study, we analyzed nationally representative data to estimate current prevalence of ASD among US children and adolescents in 2014-2016.

Altruistic sharing behavior in children: Role of theory of mind and inhibitory control

This study aimed to assess altruistic sharing behavior in children aged 3 to 5, 6 to 8, and 9 to 11 years and to explore the involvement of potential cognitive mechanisms, namely theory of mind (ToM) and inhibitory control. A total of 158 children completed a dictator game with stickers as incentives. ToM was evaluated using a false belief task in preschoolers and the Strange Story Test in school-age children. Inhibitory control was assessed in preschoolers with the Day-Night task and in older children with the Stroop Color-Word Test. The result was that 48.10% of children aged 3 to 5 years decided to share, and the percentage rose significantly with increasing age. The difference in altruism level in children who decided to share among the three age groups was nonsignificant. These results suggest that mechanisms underlying the decision to share or not and altruistic behavior may be different. No significant linear relations were found between cognitive processes (i.e., ToM and inhibitory control) and sharing behavior. Surprisingly, 9- to 11-year-olds who shared 3 of 10 stickers performed worse in inhibitory control than did those who shared any other number of stickers. In conclusion, the proportion of children who decided to share, but not the level of altruism, increased with age. ToM was not involved in altruistic sharing, whereas inhibitory control may play a role when deciding how much to share.

Bisphenol A substitutes and obesity in US adults: analysis of a population-based, cross-sectional study

Background Bisphenol F (BPF) and bisphenol S (BPS) are increasingly used to substitute bisphenol A (BPA), a widespread environmental endocrine disruptor and putative obesogen. However, studies on effects of BPF and BPS on obesity in humans are lacking. We examined the associations of BPA, BPF, and BPS exposure with obesity in U.S. adults. Methods We included 1,521 participants aged 20 years or older from a cross-sectional study, the National Health and Nutrition Examination Survey 2013-2014. Urinary BPA, BPF, and BPS concentrations were measured using on-line solid phase extraction coupled to high performance liquid chromatography and tandem mass spectrometry. We used body mass index and waist circumference to define general obesity and abdominal obesity, respectively. We used logistic regression with sample weights to estimate the odds ratios (ORs) of obesity and 95% confidence intervals. Findings Higher BPA, BPF, and BPS concentrations were observed in obese adults than non-obese adults. After adjustment for demographic, socioeconomic, lifestyle factors, and urinary creatinine concentrations, BPA, but not BPF or BPS, was significantly associated with obesity. The OR of general obesity was 1.78 (1.10-2.89) comparing the highest with lowest quartile of BPA, 1.02 (0.70-1.47) for BPF, and 1.22 (0.81-1.83) for BPS. The corresponding OR for abdominal obesity was 1.55 (1.04-2.32) for BPA, 1.05 (0.68-1.63) for BPF, and 1.16 (0.72-1.88) for BPS. Interpretation Whereas there were significant associations of BPA exposure with general and abdominal obesity, BPF or BPS, at current exposure level, was not significantly associated with obesity in U.S. adults. Continued biomonitoring of these bisphenols in populations and further investigations on their health effects in humans are warranted.

Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children

Key Points Question What are the associations of food allergy and other allergic conditions with autism spectrum disorder (ASD) in children? Findings This cross-sectional study used nationally representative data from 199 520 children aged 3 to 17 years who participated in the US National Health Interview Survey from 1997 to 2016. Children with food, respiratory, and skin allergies were significantly more likely to have ASD than children without these allergies. Meaning Common allergic conditions, in particular food allergy, are associated with ASD among US children, but the underlying mechanism for this association needs further study.

Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016

Key Points Question What are the long-term trends in prevalence of attention-deficit/hyperactivity disorder among US children and adolescents over the past 2 decades? Findings In this study of data from 186 457 children and adolescents aged 4 to 17 years from the National Health Interview Survey, a nationwide, population-based, cross-sectional survey conducted annually from 1997 to 2016, the estimated prevalence of diagnosed attention-deficit/hyperactivity disorder in US children and adolescents increased from 6.1% in 1997-1998 to 10.2% in 2015-2016. Meaning Among US children and adolescents, the estimated prevalence of diagnosed attention-deficit/hyperactivity disorder increased significantly between 1997 and 2016.

Corrected Prevalence of Autism Spectrum Disorder Among US Children and Adolescents

Corrected Prevalence of Autism Spectrum Disorder Among US Children and Adolescents To the Editor In the January 2, 2018, issue of JAMA, we published a Research Letter: “Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016.”1 Using data from the National Health Interview Survey (NHIS), we found that the weighted prevalence of autism spectrum disorder (ASD) was 2.41% (95% CI, 2.17%-2.65%) in 2014-2016. Sample weights are provided with the NHIS data for researchers to use during analysis to take into account unequal probabilities of selection and nonresponse. For the analysis of the 2016 data, we used the weights originally released by the Centers for Disease Control and Prevention (CDC) in June 2017. The CDC identified inaccuracies in the original sampling weights and updated them in November 2017, after acceptance of the Research Letter, but we did not become aware of this change until December 27, 2017. We reran all the analyses for our estimates using the updated weights. The conclusions were not changed, but there were some small changes in the results for the 2016 data and the pooled data from 2014-2016. For example, the overall prevalence of ASD changed from 2.41% to 2.47% (95% CI, 2.20%2.73%), with the estimate being within the original 95% CI. The text and table of the Research Letter have been corrected online and a correction notice accompanies this letter.2

Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study

Abstract Objective To estimate the prevalence of diagnosed total diabetes, type 1 diabetes, and type 2 diabetes in the US general population and the proportions of each among US adults with a diagnosis of diabetes. Design Nationwide, population based, cross sectional survey. Setting National Health Interview Survey, 2016 and 2017. Participants Adults aged 20 years or older (n=58 186), as a nationally representative sample of the civilian, non-institutionalized US population. Main outcome measures Prevalence of diagnosed diabetes, type 1 diabetes, and type 2 diabetes in the US general population, and the proportions of each subtype in participants with a diagnosis of diabetes. Results Among the 58 186 included adults, 6317 had received a diagnosis of diabetes. The weighted prevalence of diagnosed diabetes, type 1 diabetes, and type 2 diabetes among US adults was 9.7% (95% confidence interval 9.4% to 10.0%), 0.5% (0.5% to 0.6%), and 8.5% (8.2% to 8.8%), respectively. Type 1 diabetes was more prevalent among adults with lower education level, and type 2 diabetes was more prevalent among older adults, men, and those with lower educational level, lower family income level, and higher body mass index (BMI). Among adults with a diagnosis of diabetes, the weighted percentage of type 1 and type 2 diabetes was 5.6% (4.9% to 6.4%) and 91.2% (90.4% to 92.1%), respectively. The percentage of type 1 diabetes was higher among younger adults (age 20-44 years), non-Hispanic white people, those with higher education level, and those with lower BMI, whereas the percentage of type 2 diabetes was higher among older adults (age ≥65 years), non-Hispanic Asians, those with lower education level, and those with higher BMI. Conclusion This study provided benchmark estimates on the national prevalence of diagnosed type 1 diabetes (0.5%) and type 2 diabetes (8.5%) among US adults. Among US adults with diagnosed diabetes, type 1 and type 2 diabetes accounted for 5.6% and 91.2%, respectively.

Exposure to Bisphenol A, Bisphenol F, and Bisphenol S in U.S. Adults and Children: The National Health and Nutrition Examination Survey 2013–2014

Bisphenol F (BPF) and bisphenol S (BPS) are replacing bisphenol A (BPA) in the manufacturing of products containing polycarbonates and epoxy resins. Data on current human exposure levels of these substitutes are needed to aid in the assessment of their human health risks. This study analyzed urinary bisphenol levels in adults (N = 1808) and children (N = 868) participating in the National Health and Nutrition Examination Survey (NHANES) 2013–2014 and investigated demographic and lifestyle factors associated with urinary levels of bisphenols. BPA, BPS, and BPF were detected in 95.7, 89.4, and 66.5% of randomly selected urine samples analyzed as part of NHANES 2013–2014, respectively. Median levels of BPA in U.S. adult were higher (1.24 μg/L) than BPF and BPS levels (0.35 and 0.37 μg/L, respectively). For children, median BPA levels were also higher (1.25 μg/L) than BPF and BPS levels (0.32 and 0.29 μg/L, respectively). The limits of detection for BPA, BPF, and BPS were 0.2, 0.2, and 0.1 μg/L, respectively. Urinary levels showed associations with gender, race/ethnicity, family income, physical activity, smoking, and/or alcohol intake that depended on the specific bisphenol. The results of this study indicate that exposure of the general U.S. population to BPA substitutes is almost ubiquitous. Because exposures differ across the U.S. population, further studies of environmental, consumer, and lifestyle factors affecting BPF and BPS exposures are warranted.

Trajectories and the influencing factors of behavior problems in preschool children: a longitudinal study in Guangzhou, China

BackgroundSince child mental health problem was a global health issue, many researchers in western countries has focused on the trajectory of it to provide evidence for prevention programs. We designed this study to determine the trajectories of children’s behavior problems, and to explore the effect of parent predictors on children’s behavior problems in Guangzhou, China.MethodsChildren (N = 1480) for this longitudinal, population-based survey, were recruited from eight regular kindergartens (October, 2010) across four districts in Guangzhou. Repeated measurement design analysis was used to compare the variation in behavioral problems by gender, only child status, and temperament. Logistic regression was applied to analyze the effect of parents’ risks (maternal depression, parenting style) on the change in child problem behaviors.ResultsThe scores of behavior problems (externalizing, emotional, social communication problems) were stable during the entire preschool period by gender and child number. Children with difficult temperament exhibited more problem behaviors than children with easy temperament in the early years, and the misbehaviors declined significantly over time. Moreover, maternal depression and the increase in excessive interference/over protective or punishing parenting strategies resulted in an increase in child behavior problems.ConclusionThere was no difference between the only-child status and child with siblings in the trajectory of problem behaviors. Parent factors were significant predictions of trajectory of child behavior problem during preschool age.

Creating and supporting a healthy food environment for type 2 diabetes prevention

The widespread epidemic of type 2 diabetes mellitus in many countries renders the prevention of this condition a global priority for public health. Key modifiable risk factors for type 2 diabetes include obesity, an unhealthy diet, and a sedentary lifestyle. Individual-level interventions to promote a healthy diet and lifestyle have been proven to effectively reduce or delay the onset of type 2 diabetes. Dietary and lifestyle choices are ultimately an individual matter and are determined by one’s knowledge, attitude, beliefs, and skills. However, other factors at the family, community, and society levels could have profound effects, but these factors have not been thoroughly considered. Successful changes to promote healthy behaviours at an individual level might be best achieved with multi-level interventions that consider factors at interpersonal, organisational, community, and public policy levels (figure). At a community level, evidence increasingly suggests an association between the local food environment and diabetes. The neighbourhood food environment can affect the perceived availability of, access to, and exposure to foods and beverages. In their Article in The Lancet Planetary Health, Chinmoy Sarkar and colleagues analysed large-scale cross-sectional data from 347 551 adult participants in the UK Biobank to examine the associations of exposure to ready-to-eat food environments (such as fast food takeaways, pubs and bars, and restaurants and cafeterias) with the odds of type 2 diabetes. The authors defined ready-to-eat food environments by use of a modelled and linked built environment database and objectively measured these environments within 1-km catchment areas of the residential streets of participants. Sarkar and colleagues found that the density of ready-to-eat food environments within a 1-km street catchment was associated with higher odds of type 2 diabetes. The associations were not appreciably changed after adjustment for potential confounders, including demographics, socioeconomic status, dietary and lifestyle factors, and body-mass index. This study benefited from use of a large and well characterised cohort that represented participants from 21 major cities of UK, which provided a high statistical power to detect the associations. Socioeconomic status is a potential confounder when assessing the association between a food environment and health outcomes. It has been assumed that people in areas that comprise many individuals of low socioeconomic status have less access to resources than their affluent neighbours. Such populated areas with poor access to nutritious and affordable food are often termed so-called food deserts. However, in the study by Sarkar and colleagues, the associations persisted when several variables relevant to socioeconomic status (such as educational attainment, employment status, and income) were adjusted for, indicating that the association could not—or at least could not solely—be explained by socioeconomic disadvantage. Exposure to ready-to-eat food environments can increase the frequency of dining out and consuming ready-to-eat foods. Ready-to-eat foods are usually high in total fat or saturated fat and added sugar, which are associated with higher risk of type 2 diabetes. In terms of cooking methods, frying is more commonly used in ready-to-eat food environments than at home. Another important but usually neglected food component when inferring the associations between food and health is unwanted contamination by environmental chemicals. See Articles page e438