Solveig A. Cunningham

Health of foreign-born people in the United States: a review.

This paper identifies the overarching patterns of immigrant health in the US. Most studies indicate that foreign-born individuals are in better health than native-born Americans, including individuals of the same race/ethnicity. They tend to have lower mortality rates and are less likely to suffer from circulatory diseases, overweight/obesity, and some cancers. However, many foreign-born groups have higher rates of diabetes, some infections, and occupational injuries. There is heterogeneity in health among immigrants, whose health increasingly resembles that of natives with duration of US residence. Prospective studies are needed to better understand migrant health and inform interventions for migrant health maintenance.

Consumption of Added Sugars and Indicators of Cardiovascular Disease Risk Among US Adolescents

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among U.S. adults.1 While atherosclerosis and CVD occur later in life, their risk factors, including lipid disorders2, diabetes3, and obesity are increasingly being identified among adolescents and even children.4 Though CVD among children is rare,4 an increase in cardiometabolic risk factors at younger ages and their apparent tendency to track into adulthood5–7 highlights the need for early and effective prevention efforts. Lifestyle changes, including dietary change, have long been a central focus of efforts to reduce CVD risk. Since the 1950’s Americans have been advised to reduce their consumption of fats and cholesterol, and replace them with complex carbohydrates.8 It appears that, in part, Americans have followed this advice. But while food disappearance data suggests that fat consumption has decreased, it is refined rather than complex carbohydrates that have increased.9 While the overall health impact of this trend is unclear, several studies have shown a positive correlation between the consumption of carbohydrates – particularly some sugars - and the presence of CVD risk factors.10–12 A recent longitudinal study among women demonstrated that the incidence of CVD increased with higher consumption of sugar-sweetened beverages,13 the largest contributor of added sugars in the U.S. diet.14 Studies comparing the impact of different sugars have demonstrated that the monosaccharide fructose but not glucose, raises triglyceride levels and lowers HDL levels, suggesting that the metabolic impact may differ substantially by sugar type.12, 15 Added sugars are refined, calorie-containing sweeteners added to foods and beverages during processing or preparation. Consumption of these sugars has increased substantially in recent decades. Sugars used to sweeten soft drinks have become the largest single source of calories in the U.S. diet.16 In 1994–1996, Americans over the age of 2 y obtained nearly 16% of their total energy from added sugars; adolescents, the highest consumers, obtained more than 20% of their energy from sugars added to foods and beverages.17 Today in the U.S., the most commonly consumed added sugars are refined beet or cane sugar (sucrose) and high fructose corn syrup (HFCS),18 both of which contribute fructose and glucose, in approximately equal amounts, to the diet. Added sugars are estimated to contribute 74%–80% of the dietary fructose consumed.19, 20 Given the high consumption of added sugars among adolescents and the potential for long-term health risks associated with early diet, it is important to understand the impact of this dietary trend. The purpose of our study was to determine if there is an association between the consumption of added sugars and indicators of cardiometabolic health among U.S. adolescents.Background— Whereas increased carbohydrate and sugar consumption has been associated with higher cardiovascular disease risk among adults, little is known about the impact of high consumption of added sugars (caloric sweeteners) among US adolescents. Methods and Results— In a cross-sectional study of 2157 US adolescents in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, dietary data from one 24-hour recall were merged with added sugar content data from the US Department of Agriculture MyPyramid Equivalents databases. Measures of cardiovascular disease risk were estimated by added sugar consumption level (<10%, 10 to <15%, 15 to <20%, 20 to <25%, 25 to <30%, and ≥30% of total energy). Multivariable means were weighted to be representative of US adolescents and variances adjusted for the complex sampling methods. Daily consumption of added sugars averaged 21.4% of total energy. Added sugars intake was inversely correlated with mean high-density lipoprotein cholesterol levels (mmol/L) which were 1.40 (95% confidence interval [CI] 1.36 to 1.44) among the lowest consumers and 1.28 (95% CI 1.23 to 1.33) among the highest (P trend =0.001). Added sugars were positively correlated with low-density lipoproteins (P trend =0.01) and geometric mean triglycerides (P trend =0.05). Among the lowest and highest consumers, respectively, low-density lipoproteins (mmol/L) were 2.24 (95% CI 2.12 to 2.37) and 2.44 (95% CI 2.34 to 2.53), and triglycerides (mmol/L) were 0.81 (95% CI 0.74, 0.88) and 0.89 (95% CI 0.83 to 0.96). Among those overweight/obese (≥85th percentile body-mass-index), added sugars were positively correlated with the homeostasis model assessment (P linear trend =0.004). Conclusion— Consumption of added sugars among US adolescents is positively associated with multiple measures known to increase cardiovascular disease risk.

Data cleaning: detecting, diagnosing, and editing data abnormalities.

In this policy forum the authors argue that data cleaning is an essential part of the research process, and should be incorporated into study design.

Social Position, Psychological Stress, and Obesity: A Systematic Review

This review presents a conceptual framework for understanding the relationship between social position and obesity, focusing on stress as a contributing factor. Through a systematic review of the literature, the studies that assess associations between social position, stress levels, dietary behaviors, and obesity risk in human beings were identified. Fourteen studies were retained based upon a priori inclusion/exclusion criteria. Across studies, individuals in higher status positions tended to have lower stress levels, healthier eating patterns, and lower body weight. Higher stress was associated with less healthy dietary behaviors and with higher body weight. These patterns were more pronounced in women than in men. The nature of the stress-eating-obesity relationship is complicated, and this literature must be developed further, because its advancement may be instrumental in identifying successful stress management techniques that can be used by food and nutrition practitioners to improve nutrition-related outcomes.

Comparing three body mass index classification systems to assess overweight and obesity in children and adolescents

OBJECTIVE To compare the International Obesity Task Force (IOTF) 2005, Centers for Disease Control and Prevention (CDC) 2000, and World Health Organization (WHO) 2007 body mass index (BMI) classification systems in terms of prevalence estimation and association with demographic factors. METHODS The 18 265 children and adolescents ages 5 to 18 years (mean = 11.2 years, standard deviation = 3.9 years) in the nationally representative Colombian National Nutrition Survey of 2005 were classified as overweight or obese according to IOTF, CDC, and WHO criteria. Prevalence estimates were compared according to each system and associations with age, sex, socioeconomic status, and population density were tested. RESULTS Prevalence estimates of combined overweight and obesity differed by system (males: IOTF = 8.5%, CDC = 10.8%, WHO = 14.1%; females: IOTF = 14.6%, CDC = 13.8%, WHO = 17.1%; P < 0.001). The association between combined overweight and obesity and age and sex varied by system. The odds of having overweight and obesity in children (5 to 10 years) compared with adolescents (11 to 18 years) were: IOTF, odds ratio (OR) = 0.87 and 95% confidence interval (CI) = 0.77-0.98; CDC, OR = 1.27 and CI = 1.14-1.42; WHO, OR = 1.21 and CI = 1.08-1.35. The values for females compared with males were: IOTF, OR = 1.84 and CI = 1.6-2.10; CDC, OR = 1.33 and CI = 1.17-1.51; WHO, OR = 1.25 and CI = 1.12-1.41. CONCLUSIONS There is a lack of consistency among the three main international systems in assessing overweight and obesity in children and adolescents. Appreciably different estimates of prevalence and associations with age and sex are obtained depending on which system is used. Future studies should assess how well each system reflects valid measures of body composition.

The Role of Added Sugars in Pediatric Obesity

This article provides an overview for pediatricians and other health care providers of the role of added sugars (caloric sweeteners) in the diets of US children and the recent evidence linking added sugar consumption to increased obesity and other chronic disease risk in children. The hypothesized biologic mechanisms for these associations are summarized, and evidence-based strategies are provided that may help children and their families to reduce their sugar consumption. Primary health care providers play an important role in assessing the added sugar intake of their patients and in providing nutrition and behavior change counselling to high-risk children and their families.

Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study

BACKGROUND Programmes for lifestyle change are aimed at improving health but little is known about their effectiveness in clinical settings. The Veterans Health Administration (VA) MOVE! lifestyle change programme is the largest in the USA. We investigated whether participation in MOVE! is associated with reduced incidence of diabetes. METHODS We did a retrospective observational analysis of data from VA databases in overweight patients and obese patients with a weight-related disorder who had undergone at least 3 years of continuous outpatient care in 2005-12. We used generalised estimating equations to assess characteristics associated with MOVE! participation, and Coxs proportional hazards regression to analyse the association between participation and diabetes incidence. FINDINGS Of 1·8 million eligible individuals, 238 540 (13%) participated in the MOVE! programme. 19 367 (1% overall, 8% of participants) met criteria for intense and sustained participation (at least eight sessions within 6 months over at least a 4-month span), which was associated with greater weight loss at 3 years than low-intensity or no participation (-2·2% vs -0·64% or 0·46%). Compared with non-participation, incidence of diabetes was reduced by intense and sustained participation (hazard ratio 0·67, 95% CI 0·61-0·74) and low-intensity participation (0·80, 0·77-0·83) in MOVE!. These patterns were consistent across sex, ethnic origin, and age. Participation was most beneficial in patients with high BMI or high random glucose concentrations at baseline (both pinteraction<0·0001). INTERPRETATION Participation in the MOVE! programme was associated with weight loss and reduced incidence of diabetes, but the rate of participation was low and, therefore, selection bias could have exaggerated these effects. FUNDING US Department of Veterans Affairs, National Institutes of Health.

Pubic hair removal: a risk factor for ‘minor’ STI such as molluscum contagiosum?

Before emerging as a fashion phenomenon, removal of pubic hair was primarily done for cultural and religious reasons (eg, this is, with circumcision, one of the items of the fitra in the Muslim religion). Molluscum contagiosum virus (MCV) is a poxvirus and includes two strains: MCV1 and MCV2. MCV is generally observed in children and immunocompromised patients, and sometimes sexually transmitted. There has been an increasing incidence of sexually transmitted MCV (STMC) in the last decade.1 However, there is no proven predominance of …

Prenatal development in rural South Africa: relationship between birth weight and access to fathers and grandparents.

Birth weight is an indicator of prenatal development associated with health in infancy and childhood, and may be affected by the family environment experienced by the mother during pregnancy. Using data from KwaZulu-Natal, South Africa, we explore the importance of the mothers access to the father and grandparents of the child during pregnancy. Controlling for household socio-economic indicators and maternal characteristics, the survival and residence of the biological father with the mother are positively associated with birth weight. The type of relationship seems to matter: married women have the heaviest newborns, but co-residence with a non-marital partner is also associated with higher birth weight. Access to the maternal grandmother may also be important: women whose mothers are alive have heavier newborns, but no additional benefit is observed from residing together. Co-residence with any grandparent is not associated with birth weight after controlling for the mothers partnership.

Effect of duration and age at exposure to the Stroke Belt on incident stroke in adulthood

Objective: To assess whether there are differences in the strength of association with incident stroke for specific periods of life in the Stroke Belt (SB). Methods: The risk of stroke was studied in 24,544 black and white stroke-free participants, aged 45+, in the Reasons for Geographic and Racial Differences in Stroke study, a national population-based cohort enrolled 2003–2007. Incident stroke was defined as first occurrence of stroke over an average 5.8 years of follow-up. Residential histories (city/state) were obtained by questionnaire. SB exposure was quantified by combinations of SB birthplace and current residence and proportion of years in SB during discrete age categories (0–12, 13–18, 19–30, 31–45, last 20 years) and entire life. Proportional hazards models were used to establish association of incident stroke with indices of exposure to SB, adjusted for demographic, socioeconomic (SES), and stroke risk factors. Results: In the demographic and SES models, risk of stroke was significantly associated with proportion of life in the SB and with all other exposure periods except birth, ages 31–45, and current residence. The strongest association was for the proportion of the entire life in SB. After adjustment for risk factors, the risk of stroke remained significantly associated only with proportion of residence in SB in adolescence (hazard ratio 1.17, 95% confidence interval 1.00–1.37). Conclusions: Childhood emerged as the most important period of vulnerability to SB residence as a predictor of future stroke. Improvement in childhood health circumstances should be considered as part of long-term health improvement strategies in the SB.