Guixiang Zhao

Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US

Background:u2002 Recently, a Joint Scientific Statement bridged differences between previous definitions of metabolic syndrome. Our objective was to estimate the prevalence of metabolic syndrome in a representative sample of US adults and to examine its correlates.

Pre-Diabetes and the Risk for Cardiovascular Disease: A Systematic Review of the Evidence

OBJECTIVESnOur objective was to estimate the magnitude of the relative risk (RR) for cardiovascular disease associated with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) from published prospective observational studies.nnnBACKGROUNDnHyperglycemia is a known risk factor for cardiovascular disease. However, the magnitude of the RR for cardiovascular disease associated with IFG and IGT is unclear.nnnMETHODSnWe searched PubMed from 1997 through 2008 for relevant publications and performed a meta-analysis.nnnRESULTSnIn 18 publications with information about IFG (110 to 125 mg/dl) (IFG 110), estimates of RR ranged from 0.65 to 2.50. The fixed-effects summary estimate of RR was 1.20 (95% confidence interval [CI]: 1.12 to 1.28). In 8 publications with information about IFG (100 to 125 mg/dl) (IFG 100), estimates of RR ranged from 0.87 to 1.40. The fixed-effects summary estimate of RR was 1.18 (95% CI: 1.09 to 1.28). In 8 publications with information about IGT, estimates of RR ranged from 0.83 to 1.34. The fixed-effects summary estimate of RR was 1.20 (95% CI: 1.07 to 1.34). Five studies combined IFG and IGT, yielding a fixed-effects summary estimate of RR of 1.10 (95% CI: 0.99 to 1.23). No significant difference between the summary estimates for men and women were detected (IFG 110: men: 1.17 [95% CI: 1.05 to 1.31], women: 1.30 [95% CI: 1.10 to 1.54]; IFG 100: men: 1.23 [95% CI: 1.06 to 1.42], women: 1.16 [95% CI: 0.99 to 1.36]).nnnCONCLUSIONSnImpaired fasting glucose and IGT are associated with modest increases in the risk for cardiovascular disease.

Trends in hypercholesterolemia, treatment and control among United States adults.

BACKGROUNDnControl of hypercholesterolemia is an important clinical and public health objective, yet it is generally poor. The objective of this study was to examine trends in the prevalence of hypercholesterolemia, having a cholesterol check, awareness, treatment, and control among United States adults.nnnMETHODSnWe examined data for 18053 participants aged > or =20 years of the National Health and Nutrition Examination Surveys from 1999 to 2006.nnnRESULTSnThe unadjusted prevalence of hypercholesterolemia ranged from 53.2% to 56.1% and changed little over the study period. Significant increases were evident in the percentage of United States adults who had their concentration of cholesterol checked (from 68.6% to 74.8%), who reported being told that they had high hypercholesterolemia (from 42.0% to 50.4%), who reported using cholesterol-lowering medications (from 39.1% to 54.4%), and who had their hypercholesterolemia controlled (from 47.0 to 64.3%). Among all participants with hypercholesterolemia control of hypercholesterolemia increased from 7.2% to 17.1%. Disparities related to gender and race or ethnicity existed, notably a lower rate of control among women than men and lower rates of having a cholesterol check and reporting being told about hypercholesterolemia among African Americans and Mexican Americans than whites.nnnCONCLUSIONSnEncouraging increases in awareness, treatment, and control of hypercholesterolemia occurred from 1999 through 2006. Nevertheless, control of hypercholesterolemia remains poor.

Trends in the Prevalence of Low Risk Factor Burden for Cardiovascular Disease Among United States Adults

Background— Cohorts consistently show that individuals with low levels of cardiovascular risk factors experience low rates of subsequent cardiovascular events. Our objective was to examine the prevalence and trends in low risk factor burden for cardiovascular disease among adults in the US population. Methods and Results— We used data from adults 25 to 74 years of age who participated in 4 national surveys. We created an index of low risk from the following variables: not currently smoking, total cholesterol <5.17 mmol/L (<200 mg/dL) and not using cholesterol-lowering medications, systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg and not using antihypertensive medications, body mass index <25 kg/m2, and not having been previously diagnosed with diabetes mellitus. The age-adjusted prevalence of low risk factor burden increased from 4.4% during 1971 to 1975 to 10.5% during 1988 to 1994 before decreasing to 7.5% during 1999 to 2004 (P for nonlinear trend <0.001). The patterns were similar for men and women, although the prevalence among women exceeded that among men in each survey (P<0.001 for each survey). In addition, whites had a significantly higher prevalence of low risk factor burden than blacks during each survey except during 1976 to 1980 (1971 to 1975, 1988 to 1994, 1999 to 2004: P<0.001; 1976 to 1980: P=0.154). Furthermore, a larger percentage of whites had a low risk factor burden than Mexican Americans during 1988 to 1994 (P<0.001) and 1999 to 2004 (P=0.001). Conclusions— The prevalence of low risk factor burden for cardiovascular disease is low. The progress that had been made during the 1970s and 1980s reversed in recent decades.

Physical Activity in U.S. Older Adults with Diabetes Mellitus: Prevalence and Correlates of Meeting Physical Activity Recommendations

OBJECTIVES: To compare the prevalence and correlates of meeting current recommendations for physical activity in older adults with and without diabetes mellitus (DM) in the United States.

No associations between serum concentrations of 25-hydroxyvitamin D and parathyroid hormone and depression among US adults.

Although there is evidence that vitamin D deficiency may play a role in depression, studies done on the associations have yielded mixed results. The present study aimed to examine the associations between serum concentrations of 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) and the presence of depression among US adults. A cross-sectional, population-based sample (including 3916 participants aged ≥ 20 years) from the 2005-6 National Health and Nutrition Examination Survey was used. Participants depressive symptoms were assessed using the Patient Health Questionnaire-9 diagnostic algorithm. The associations of 25(OH)D and PTH with depression were explored using multivariate logistic regression models. For all the participants, the age-adjusted prevalence was 5.3 (95 % CI 4.3, 6.5) % for having moderate-to-severe depression, 2.3 (95 % CI 1.7, 3.1) % for having major depression and 3.8 (95 % CI 3.0, 4.6) % for having minor depression. Although the age-adjusted prevalence and the unadjusted OR of having moderate-to-severe depression or major depression decreased linearly with increasing quartiles of 25(OH)D (P < 0.05 for trends), no significant associations remained after adjusting for multiple potential confounders such as demographic variables, lifestyle factors and coexistence of a number of chronic conditions. Neither the age-adjusted prevalence nor the OR (unadjusted or adjusted) of having depression differed significantly by the quartiles of PTH. Thus, in contrast to some of the previous findings, the present results did not show significant associations between serum concentrations of 25(OH)D and PTH and the presence of moderate-to-severe depression, major depression or minor depression among US adults. However, these findings need to be further confirmed in future studies.

Concentrations of Low-Density Lipoprotein Cholesterol and Total Cholesterol Among Children and Adolescents in the United States

Background— Recently, the American Academy of Pediatrics updated guidance on lipid screening in childhood. Our objective was to examine recent distributions in concentrations of total cholesterol and low-density lipoprotein cholesterol among US children and adolescents and to estimate the prevalence of adolescents who are potentially eligible for pharmacological treatment for elevated concentrations of low-density lipoprotein cholesterol. Methods and Results— We used data from the National Health and Nutrition Examination Survey 1999 to 2006 for participants 6 to 17 years of age. The mean concentration for low-density lipoprotein cholesterol for participants 12 to 17 years of age was 90.2 mg/dL (n=2724), and the mean concentration of total cholesterol among participants 6 to 17 years of age was 163.0 mg/dL (n=9868). Depending on the cut points used, an elevated concentration of low-density lipoprotein cholesterol was noted for 5.2% to 6.6% of participants and an elevated concentration of total cholesterol for 9.6% to 10.7%. Approximately 0.8% of adolescents 12 to 17 years of age were potentially eligible for pharmacological treatment for elevated concentrations of low-density lipoprotein cholesterol. Conclusion— Given current guidelines, only a small percentage of US adolescents may need pharmacological treatment for elevated concentrations of low-density lipoprotein cholesterol.

A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007–2008

OBJECTIVEnTo compare the prevalence estimates of selected health indicators and chronic diseases or conditions among three national health surveys in the United States.nnnMETHODSnData from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2007 and 2008 (n=807,524), the National Health Interview Survey (NHIS) in 2007 and 2008 (n=44,262), and the National Health and Nutrition Examination Survey (NHANES) during 2007 and 2008 (n=5871) were analyzed.nnnRESULTSnThe prevalence estimates of current smoking, obesity, hypertension, and no health insurance were similar across the three surveys, with absolute differences ranging from 0.7% to 3.9% (relative differences: 2.3% to 20.2%). The prevalence estimate of poor or fair health from BRFSS was similar to that from NHANES, but higher than that from NHIS. The prevalence estimates of diabetes, coronary heart disease, and stroke were similar across the three surveys, with absolute differences ranging from 0.0% to 0.8% (relative differences: 0.2% to 17.1%).nnnCONCLUSIONnWhile the BRFSS continues to provide invaluable health information at state and local level, it is reassuring to observe consistency in the prevalence estimates of key health indicators of similar caliber between BRFSS and other national surveys.

PREVALENCE AND CORRELATES OF UNDIAGNOSED DEPRESSION AMONG U.S. ADULTS WITH DIABETES: THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, 2006

AIMSnMany people with depression may be undiagnosed and thus untreated. We sought to assess the prevalence and correlates of undiagnosed depression among adults with diabetes.nnnMETHODSnData of U.S. adults from the Behavioral Risk Factor Surveillance System in 2006 were analyzed. Cox proportional hazard regression analysis was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of correlates for undiagnosed depression.nnnRESULTSnThe unadjusted and age-adjusted prevalences of undiagnosed depression were 8.7% and 9.2%. About 45% of diabetes patients with depression were undiagnosed. After adjustments for all correlates, female gender (PR, 1.4; 95% CI: 1.1-1.8), poor or fair health (PR, 2.8; 95% CI: 2.1-3.6), lack of social and emotional support (PR, 2.5; 95% CI: 1.8-3.3), life dissatisfaction (PR, 3.5; 95% CI: 2.2-5.5), use of special equipment (PR, 1.4; 95% CI: 1.1-1.8), no leisure-time physical activity (PR, 1.5; 95% CI: 1.2-1.9), and comorbid cardiovascular disease (PR, 1.5; 95% CI: 1.2-1.9) were associated with undiagnosed depression.nnnCONCLUSIONSnUndiagnosed depression among people with diabetes was common. Because depression is associated with increased risk of diabetes-related complications, early detection of depression is needed in clinical settings.

Body mass index and headaches: findings from a national sample of US adults

The objective was to study the cross-sectional association between body mass index (BMI) and the prevalence of severe headaches or migraines in a national sample of US adults. We used data from 7601 men and women aged ≥ 20 years who participated in the National Health and Nutrition Examination Survey 1999-2002. The age-adjusted prevalence of severe headaches or migraines during the previous 3 months was 34.0, 18.9, 20.7 and 25.9± among participants with a BMI< 18.5, 18.5 to< 25, 25 to< 30 and ≥ 30 kg/m2, respectively. After adjusting for a variety of covariates in a logistic regression model, those with a BMI< 18.5 kg/m2 [odds ratio (OR) 2.01; 95± confidence interval (CI) 1.34, 3.02] or ≥ 30 kg/m2 (OR 1.37; 95± CI 1.09, 1.72) had a significantly elevated OR for having a headache compared with participants with a BMI of 18.5-< 25 kg/m2. BMI is associated with the prevalence of severe headaches or migraines in a non-linear manner.