Gary Liguori

Persistent Increase of Prevalence of Metabolic Syndrome Among U.S. Adults: NHANES III to NHANES 1999–2006

OBJECTIVE To compare the prevalence in metabolic syndrome (MetSyn) between 1988–1994 and 1999–2006 among U.S. adults of different races or ethnicities. RESEARCH DESIGN AND METHODS Analysis of data on 6,423 adult men and nonpregnant women aged ≥20 years from Third National Health and Nutrition Examination Survey (NHANES III) and 6,962 participants from the combined NHANES 1999–2006 were done. The revised National Cholesterol Education Program Adult Treatment Panel III definition was used to calculate MetSyn. RESULTS Both the unadjusted prevalence (27.9 ± 1.1% to 34.1 ± 0.8%, P < 0.001) and age-adjusted prevalence (29.2 ± 1.0% to 34.2 ± 0.7%, P < 0.001) increased from NHANES III to NHANES 1999–2006, respectively. Although MetSyn prevalence was highest in Mexican Americans, significant increases in prevalence occurred among non-Hispanic whites and non-Hispanic blacks, especially among younger women. CONCLUSIONS The persistent increase of MetSyn among U.S. adults is a serious public health concern because it raises the likelihood of increased prevalence of type 2 diabetes.

Changes in Metabolic Syndrome in American and Korean Youth, 1997–2008

BACKGROUND: Metabolic syndrome (MetSyn) in children and adolescence is increasing worldwide; however, its pattern may be different between Asians and Americans. We compare the prevalence and patterns of MetSyn between American and Korean children and adolescents between roughly 1998 and 2007. METHODS: Data from the American and Korean versions of the NHANES (NHANES and KNHANES) were used for this study. The main outcome is prevalence and pattern of MetSyn among participants separately in each country. In each survey, stratified multistage probability sampling designs and weighting adjustments were conducted to represent the entire population. The revised National Cholesterol Education Program criteria were used to define MetSyn. RESULTS: Totals of 934, 1781, and 1690 Americans aged 12 to 19 participated in NHANES 1988–1994, NHANES 1999–2002, and NHANES 2003–2006, respectively; and 1225, 976, 705, and 456 Koreans aged 12 to 19 have participated in KNHANES 1998, 2001, 2005, and 2007. The age-adjusted prevalence of MetSyn in American NHANES decreased from 7.3% to 6.7% and 6.5%, whereas in Korean NHANES there was an increase from 4.0% to 5.9%, 6.6%, and 7.8% in each country’s respective study. Increases in dyslipidemia and abdominal obesity contributed to the increased prevalence in Korea, whereas in the United States, decreases in low high-density lipoprotein cholesterolemia and high blood pressure contributed to a decreased prevalence. CONCLUSIONS: Considering different phenotype changes, different approaches should be conducted at the national level to reduce the burden and consequences of MetSyn between Korea and the United States.

Corrective Equations to Self-Reported Height and Weight for Obesity Estimates Among U.S. Adults: NHANES 1999–2008

Purpose: Estimating obesity prevalence using self-reported height and weight is an economic and effective method and is often used in national surveys. However, self-reporting of height and weight can involve misreporting of those variables and has been found to be associated to the size of the individual. This study investigated the biases in self-reporting of height and weight in the U.S. adult population and generated age-adjusted correction equations for self-reported height and weight separately for each ethnic groups specific height and weight quartile sample. Validity of the body mass index (BMI) classification calculated from corrected self-reported height and weight was also examined. Method: Data on self-reporting and direct measurement of height and weight from National Health and Nutrition Examination Survey 1999–2008 were analyzed. The final sample included 11,521 men and 10,905 nonpregnant women who were all U.S. citizens aged 20 years or older. Results: A variation in misreporting of self-reported height and weight depended on the gender, ethnicity, age, and size of the individual. The results from sensitivity and specificity analyses showed that the BMI calculated from corrected values of self-reported height and weight provided more accurate estimations of overweight and obesity than did BMI calculated from self-reported height and weight. Conclusion: In spite of some methodological concerns, the correction equation of self-reported height and weight generated in this study can be utilized as a method for quick assessment of estimating the obesity and overweight prevalence in the U.S. adult population.

Knowledge and Beliefs That Promote or Hinder Collaboration among Registered Dietitian Nutritionists and Certified Exercise Professionals—Results of a Survey

C HRONIC DISEASES ARE THE leading cause of death and disability in the United States and represent >86% of current health care spending. In 2012, it was estimated that half of US adults had one or more chronic diseases, many of which can be prevented or managed with lifestyle changes, such as physical activity (PA), weight management, and healthful dietary choices. Increased awareness of the detrimental effects of chronic disease on health has led to consumer interest in the impact of PA and diet on weight management and overall health. In a 2015 survey of US adults, 91% reported having given “at least some/little thought” about the healthfulness of their diet, and 94% reported having given “at least some/little thought” about the amount of PA they get, and 84% said they were actively trying to maintain or lose weight. Given the increasing consumer interest in the healthfulness of their diet and their PA level, it is important that consumers know which allied health professionals are best qualified to provide guidance in these areas. Health professionals in the fields of food, nutrition, and PA are in a unique position to address the rising tide of chronic disease, inactivity, and obesity. Thus, the US Department of Agriculture, the Academy of Nutrition and Dietetics (the Academy), the American College of Sports Medicine (ACSM), and the International Food Information Council (IFIC) Foundation collaborated on an expert panel meeting and report outlining ways to train practitioners regarding the integrated roles of food and nutrition, PA, and behavior change in improving the nation’s health. The report also focused on the need for registered dietitian nutritionists (RDNs) and exercise professionals to understand the Scope of Practice (SOP) and language used within each profession and the role each plays in assisting clients. Although RDNs and ACSM-certified exercise professionals (hereafter, ACSM certificants) have distinct roles in assisting clients, neither are typically trained to provide guidance on both healthful eating and PA. Thus, an awareness of each other’s knowledge, skills, and SOP allows these health professionals to work collaboratively to improve consumers’ knowledge of healthful eating and PA and assist in making behavioral changes. Nearly 20 years ago, ACSM, the Academy, and the IFIC Foundation surveyed a national sample of Academy (n1⁄4306) and ACSM (n1⁄4317) members to determine each profession’s attitudes about the other profession. At that time, 65% of RDNs surveyed reported providing PA guidance to >70% of their clients, yet only 14% felt that they could provide all of the PA information their clients needed. Similarly, 70% of exercise professionals reported giving clients advice and guidance about healthful eating and 57% thought they knew

Applying the Acsm Preparticipation Screening Algorithm to U.s. Adults: National Health and Nutrition Examination Survey 2001–2004

Purpose For most people, the benefits of physical activity far outweigh the risks. Research has suggested that exercise preparticipation questionnaires might refer an unwarranted number of adults for medical evaluation before exercise initiation, creating a potential barrier to adoption. The new American College of Sports Medicine (ACSM) prescreening algorithm relies on current exercise participation; history and symptoms of cardiovascular, metabolic, or renal disease; and desired exercise intensity to determine referral status. Our purpose was to compare the referral proportion of the ACSM algorithm to that of previous screening tools using a representative sample of U.S. adults. Methods On the basis of responses to health questionnaires from the 2001–2004 National Health and Nutrition Examination Survey, we calculated the proportion of adults 40 yr or older who would be referred for medical clearance before exercise participation based on the ACSM algorithm. Results were stratified by age and sex and compared with previous results for the ACSM/American Heart Association Preparticipation Questionnaire and the Physical Activity Readiness Questionnaire. Results On the basis of the ACSM algorithm, 2.6% of adults would be referred only before beginning vigorous exercise and 54.2% of respondents would be referred before beginning any exercise. Men were more frequently referred before vigorous exercise, and women were more frequently referred before any exercise. Referral was more common with increasing age. The ACSM algorithm referred a smaller proportion of adults for preparticipation medical clearance than the previously examined questionnaires. Conclusions Although additional validation is needed to determine whether the algorithm correctly identifies those at risk for cardiovascular complications, the revised ACSM algorithm referred fewer respondents than other screening tools. A lower referral proportion may mitigate an important barrier of medical clearance from exercise participation.

Seasonal Changes in Preschoolers’ Sedentary Time and Physical Activity at Childcare

Background : This investigation evaluated seasonal changes in preschoolers’ (3-5 years) sedentary time and physical activity (PA) during childcare. Methods : Sixty-two children from 4 preschools in Fargo, North Dakota had their sedentary behavior and PA objectively assessed during 2 separate weeks of childcare. Children wore accelerometers for 5 consecutive days, once each in the fall (October/November) and winter (January/February). Separate analyses were conducted to evaluate seasonal changes in full-day, indoor only, and outdoor only sedentary time and PA during childcare. Results : When expressed relative to accelerometer wear time, the full-day rate of sedentary time accumulation (minutes/hour) increased significantly from fall to winter ( p < 0.001), while accumulation rates for all other PA variables (light PA, moderate PA, moderate-to-vigorous PA, and activity counts) significantly declined during this period (all p ’s < 0.001). No significant changes in accumulation rates for sedentary time or PA (light PA, moderate PA, moderate-to-vigorous PA, and activity counts) were noted for either indoor or outdoor time between seasons. Conclusions : Childcare-related sedentary time and PA can dramatically vary across seasons.