James Tsai

Low-Risk Lifestyle Behaviors and All-Cause Mortality: Findings From the National Health and Nutrition Examination Survey III Mortality Study

Objectives. We examined the relationship between 4 low-risk behaviors—never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption—and mortality in a representative sample of people in the United States.Methods. We used data from 16958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006.Results. The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio [AHR]=0.37; 95% confidence interval [CI]=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high-risk behavior...

Waist circumference, abdominal obesity, and depression among overweight and obese U.S. adults: national health and nutrition examination survey 2005-2006

BackgroundObesity is associated with an increased risk of mental illness; however, evidence linking body mass index (BMI)-a measure of overall obesity, to mental illness is inconsistent. The objective of this study was to examine the association of depressive symptoms with waist circumference or abdominal obesity among overweight and obese U.S. adults.MethodsA cross-sectional, nationally representative sample from the 2005-2006 National Health and Nutrition Examination Survey was used. We analyzed the data from 2,439 U.S. adults (1,325 men and 1,114 nonpregnant women) aged ≥ 20 years who were either overweight or obese with BMI of ≥ 25.0 kg/m2. Abdominal obesity was defined as waist circumference of > 102 cm for men and > 88 cm for women. Depressive symptoms (defined as having major depressive symptoms or moderate-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having major depressive symptoms and moderate-to-severe depressive symptoms were estimated using logistic regression analysis.ResultsAfter multivariate adjustment for demographics and lifestyle factors, waist circumference was significantly associated with both major depressive symptoms (OR: 1.03, 95% CI: 1.01-1.05) and moderate-to-severe depressive symptoms (OR: 1.02, 95% CI: 1.01-1.04), and adults with abdominal obesity were significantly more likely to have major depressive symptoms (OR: 2.18, 95% CI: 1.35-3.59) or have moderate-to-severe depressive symptoms (OR: 2.56, 95% CI: 1.34-4.90) than those without. These relationships persisted after further adjusting for coexistence of multiple chronic conditions and persisted in participants who were overweight (BMI: 25.0-< 30.0 kg/m2) when stratified analyses were conducted by BMI status.ConclusionAmong overweight and obese U.S. adults, waist circumference or abdominal obesity was significantly associated with increased likelihoods of having major depressive symptoms or moderate-to-severe depressive symptoms. Thus, mental health status should be monitored and evaluated in adults with abdominal obesity, particularly in those who are overweight.

Multiple healthy behaviors and optimal self-rated health: Findings from the 2007 Behavioral Risk Factor Surveillance System Survey ☆

OBJECTIVE The aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal self-rated health (SRH) among U.S. adults or adults with cardiovascular diseases (CVDs) or diabetes. METHODS We estimated the age-standardized prevalence of optimal SRH among a total of 430,912 adults who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using number of healthy behaviors as a predictor; status of optimal SRH was used as an outcome variable while controlling for sociodemographic and health risk factors. RESULTS The age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3% among adults overall, and adults with CVDs or diabetes, respectively. Also in the aforementioned order, adults who reported having four healthy behaviors had 33%, 85%, and 87% increased likelihoods of reporting optimal SRH, when compared to their counterparts who reported none of these behaviors. CONCLUSION The findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple healthier lifestyle behaviors among adults.

Patterns and Average Volume of Alcohol Use Among Women of Childbearing Age

Objectives: Maternal alcohol use is a leading preventable cause of neurobehavioral and developmental abnormalities in children. This study examines the patterns and average volume of alcohol use among U.S. women of childbearing age in order to identify subgroups of high-risk women for selective intervention. Methods: A sample of 188,290 women aged 18–44 years participated in the Centers for Disease Controls and Prevention (CDC)’s Behavioral Risk Factor Surveillance System (BRFSS) survey during the period of 2001–2003. Reported alcohol use patterns and average volume were examined for pregnant and nonpregnant women. Efforts were made to evaluate and characterize women who practiced various levels of binge drinking. Results: The results showed that approximately 2% of pregnant women and 13% of nonpregnant women in the United States engaged in binge drinking during the period of 2001–2003. Among the estimated average of 6.7 million women of childbearing age overall who engaged in binge drinking during the period, approximately 28.5% women also reported consuming an average of 5 drinks or more on typical drinking days, or about 21.4% women consumed at least 45 drinks on average in a month. Larger proportions of binge drinkers with high usual quantity of consumption were found among women of younger ages (18–24 years) or current smokers. Conclusions: Future prevention efforts should include strategies that combine health messages and encourage women of childbearing age, with particular emphasis on women 18–24 years, to avoid alcohol and tobacco use, and take multivitamins and folic acid daily for better pregnancy outcomes. Other efforts must also include broad-based implementation of screening and brief intervention for alcohol misuse in primary and women’s health care settings.

Sedentary behavior, physical activity, and concentrations of insulin among US adults

Time spent watching television has been linked to obesity, metabolic syndrome, and diabetes, all conditions characterized to some degree by hyperinsulinemia and insulin resistance. However, limited evidence relates screen time (watching television or using a computer) directly to concentrations of insulin. We examined the cross-sectional associations between time spent watching television or using a computer, physical activity, and serum concentrations of insulin using data from 2800 participants aged at least 20 years of the 2003-2006 National Health and Nutrition Examination Survey. The amount of time spent watching television and using a computer as well as physical activity was self-reported. The unadjusted geometric mean concentration of insulin increased from 6.2 microU/mL among participants who did not watch television to 10.0 microU/mL among those who watched television for 5 or more hours per day (P = .001). After adjustment for age, sex, race or ethnicity, educational status, concentration of cotinine, alcohol intake, physical activity, waist circumference, and body mass index using multiple linear regression analysis, the log-transformed concentrations of insulin were significantly and positively associated with time spent watching television (P = < .001). Reported time spent using a computer was significantly associated with log-transformed concentrations of insulin before but not after accounting for waist circumference and body mass index. Leisure-time physical activity but not transportation or household physical activity was significantly and inversely associated with log-transformed concentrations of insulin. Sedentary behavior, particularly the amount of time spent watching television, may be an important modifiable determinant of concentrations of insulin.

Vitamin D and all-cause mortality among adults in USA: findings from the National Health and Nutrition Examination Survey Linked Mortality Study

BACKGROUND Whether concentrations of vitamin D are related to mortality remains unresolved. Our objective was to examine the relationship between serum concentrations of 25-hydroxyvitamin D and all-cause mortality in a national sample of US adults. METHODS We used data from the National Health and Nutrition Examination Survey Mortality Study from 2001 to 2004 with mortality compiled through 2006. Mortality status was established through a match to the National Death Index. RESULTS Of the 7531 participants, 347 died. Median follow-up was 3.8 years. The mean unadjusted concentrations of vitamin D were 54.1 nmol/l (21.7 ng/ml) among participants who died and 60.7 nmol/l (24.3 ng/ml) among participants who survived (P = 0.002). After adjustment for socio-demographic factors, the hazard ratios (HR) for all-cause mortality were 1.65 [95% confidence interval (CI): 95% CI: 1.13-2.40] for participants with a concentration <50 nmol/l (<20 ng/ml) and 1.02 (95% CI: 0.74-1.41) for participants with a concentration of 50 to <75 nmol/l (20 to <30 ng/ml) compared with participants who had a concentration of ≥ 75 nmol/l (≥ 30 ng/ml). After more extensive adjustment, the HRs were 1.28 (95% CI: 0.86-1.90) and 0.91 (95% CI: 0.63-1.33), respectively. The fully adjusted HR per 10 nmol/l of vitamin D was 0.93 (95% CI: 0.86-1.01). The HRs did not vary by gender (P = 0.80) or among the three major racial or ethnic groups (P = 0.46). CONCLUSIONS Concentrations of vitamin D were weakly and inversely related to all-cause mortality in this sample of US adults.

Physical activity and optimal self-rated health of adults with and without diabetes

BackgroundRegular physical activity can improve peoples overall health and contribute to both primary and secondary prevention of many chronic diseases and conditions including diabetes. The aim of this study was to examine the association between levels of physical activity and optimal self-rated health (SRH) of U.S. adults with and without diabetes in all 50 states and territories of the Unites States.MethodsWe estimated the prevalence of optimal SRH by diabetes status of 430,912 adults aged 18 years and older who participated in the 2007 state-based survey of the Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using levels of physical activity as a predictor and status of optimal SRH as an outcome variable while controlling for sociodemographic and behavioral health risk factors.ResultsThe prevalence of reporting optimal SRH was 53.3%, 52.2%, and 86.2% for adults with type 1 diabetes, type 2 diabetes, and without diabetes, respectively. Also in the aforementioned order, adults who reported being active had an increased likelihood of 81%, 32%, and 18% for reporting optimal SRH, when compared with adults who reported being inactive.ConclusionsRegular physical activity of adults, particularly adults with diabetes, is associated with optimal SRH. The findings of this study underscore the importance of advising and motivating adults with diabetes so that physical activity can be integrated into their lifestyle for diabetes care. Additionally, a population-based effort to promote physical activity in communities may benefit adults in general by improving their overall health and well-being.

Past and current alcohol consumption patterns and elevations in serum hepatic enzymes among US adults.

OBJECTIVE The aim of this study was to examine the association between patterns of past and current alcohol consumption and elevations in serum hepatic enzymes among a nationally representative sample of adults in the United States. METHODS We estimated the age-adjusted prevalence of elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among 8993 adults aged 20 years or older who participated in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). We produced prevalence ratios by using patterns of alcohol consumption as a predictor; elevations in serum ALT, AST, and GGT were used as an outcome variable while adjusting for covariates in multivariate regression models. RESULTS The age-adjusted prevalence of elevated serum ALT, AST, and GGT in adults was 9.7%, 16.0%, and 8.6%, respectively. Male excessive current drinkers had 50%-71% and 75%-314% increased likelihoods of having elevated serum AST and GGT, respectively; female excessive drinkers with a history of consuming 5 or more drinks almost daily had a 226% increased likelihood of having elevated serum GGT, when compared to their respective counterparts who were lifetime abstainers. CONCLUSIONS The results of this study indicate that elevations in serum hepatic enzymes, especially AST and GGT, are common in adults who are excessive current drinkers. There is evidence to suggest that excessive current drinkers with a history of protracted drinking are especially vulnerable to potential liver injury. These findings lend further support to the early identification of excessive drinkers who may have an increased risk for alcohol-related morbidity and mortality in health care settings.

Trends in In-Hospital Deaths Among Hospitalizations With Pulmonary Embolism

P ulmonary embolism (PE) is a potentially lifethreatening condition that typically occurs when a thrombus from deep veins in the leg, pelvis, arms, or heart embolizes to the lungs. Recent data linked PE to approximately 247 000 hospitalizations in the United States in 2006. To our knowledge, the casefatality rate and estimated number of in-hospital deaths among a national representative example of hospitalizations that encompass first-listed and any-listed PE diagnoses in the United States are limited. Therefore, we report nationally representative estimates of in-hospital deaths (ie, annual number and case-fatality rate) among hospitalizations with a PE diagnosis (ie, first-listed and any-listed) in the United States by analyzing data from the 2001-2008 National Hospital Discharge Survey (NHDS).

Association Between Diagnosed Diabetes and Self-Reported Cancer Among U.S. Adults: Findings from the 2009 Behavioral Risk Factor Surveillance System

OBJECTIVE To assess the association between diagnosed diabetes and self-reported cancer among U.S. adults. RESEARCH DESIGN AND METHODS We analyzed data for 397,783 adults who participated in the 2009 Behavioral Risk Factor Surveillance System and had valid data on diabetes and cancer. RESULTS After adjustment for potential confounders, diabetic men had higher adjusted prevalence ratios for cancers of the prostate (1.1 [95% CI 1.0–1.3]), colon (1.3 [1.0–1.7]), pancreas (4.6 [1.8–11.7]), rectum (2.2 [1.0–4.7]), urinary bladder (1.7 [1.2–2.2]), and kidney (1.9 [1.2–3.0]) than nondiabetic men (all P < 0.05). Diabetic women had higher adjusted prevalence ratios for cancers of the breast (1.1 [1.0–1.3]) and endometrium (1.6 [1.2–2.0]), and leukemia (2.3 [1.3–4.2]) than nondiabetic women (all P < 0.05). CONCLUSIONS Our results suggest that diabetic adults have higher prevalences of certain cancers than nondiabetic adults.