Correlation between Dietary Intake of Vitamins and Oral Health Behaviors: A Cross-Sectional Study.

This study aimed to investigate whether oral health behaviors were related to the dietary intake of vitamins. In this cross-sectional study, we included respondents of the 2016 national health and nutrition examination survey, and dental diseases from Hyogo Prefecture, Japan. Data on sociodemographic characteristics, findings of blood tests related to metabolic syndrome, dietary intake, oral health status, and behaviors were collected. Participants were divided into two groups based on their oral health behavior: the yes group (performed interdental cleaning or tongue brushing) and the no group (did not perform the behaviors). The study included 218 participants (male: 107, female: 111) aged 64.5 (range, 22-93) years. There were 133 (61.0%) and 85 (39.0%) participants in the yes and no groups, respectively. The daily intake of vitamins A, B2, B6, E, and K, folic acid, and niacin in the yes group was significantly higher than that in the no group. Oral health behavior correlated with the intake of vitamin B2 (p = 0.029), folic acid (p = 0.006), and vitamin K (p = 0.043) after adjusting for possible confounders. Oral health behavior (interdental cleaning or tongue brushing) correlated with the daily intake of vitamins B2, K, and folic acid.

Epidemiology and Disease Burden of Alcohol Associated Liver Disease.

Consumption of alcohol in excess leads to substantial medical, economic, and societal burdens. Approximately 5.3% of all global deaths may be attributed to alcohol consumption. Moreover, the burden of alcohol associated liver disease (ALD) accounts for 5.1% of all disease and injury worldwide. Alcohol use disorder (AUD) affects men more than women globally with significant years of life loss to disability in low, middle and well-developed countries. Precise data on global estimates of alcohol related steatosis, alcohol related hepatitis, and alcohol related cirrhosis have been challenging to obtain. In the United States (US), alcohol related steatosis has been estimated at 4.3% based on NHANES data which has remained stable over 14 years. However, alcohol-related fibrotic liver disease has increased over the same period. In those with AUD, the prevalence of alcohol related hepatitis has been estimated at 10-35%. Globally, the prevalence of alcohol-associated cirrhosis has been estimated at 23.6 million individuals for compensated cirrhosis and 2.46 million for those with decompensated cirrhosis. The contribution of ALD to global mortality and disease burden of liver related deaths is substantial. In 2016 liver disease related to AUD contributed to 50% of the estimated liver disease deaths for age groups 15 years and above. Data from the US report high cost burdens associated with those admitted with alcohol-related liver complications. Finally, the recent COVID-19 pandemic has been associated with marked increase in alcohol consumption worldwide and will likely increase the burden of ALD.

Characteristics and difference of respiratory diseases in Korean adults aged ≥40 years: A cross-sectional study.

PURPOSE: National big data pertaining to the status of common respiratory diseases is essential to devising appropriate policies to promote proper treatment and prevention of respiratory diseases amid the prolonged coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to investigate the prevalence of common respiratory diseases and their association with sociodemographic characteristics, comorbidities, and medical history using 11 years (2008-2018) of the Korea National Health and Nutrition Examination Survey (KNHANES) data, ultimately to present foundational data for policy decision making and disease prevention measures. METHODS: Among the participants of the KNHANES survey (2008-2018), 93 028 adults aged ≥40 years who underwent a lung function test were included in this cross-sectional study. The participants were divided into four groups: Asthma, chronic obstructive pulmonary disease (COPD), asthma + COPD, and no respiratory disease. Their data were analyzed for demographic factors, health behavior, and disease-related factors. Multiple logistic regression was used to calculate the odds ratio (OR) adjusted for sex, age, household income, educational level, occupation, body mass index (BMI), smoking status, alcohol consumption, physical activity, and comorbidities. RESULTS: Of all participants, 1.83%, 12.63%, and 1.27% had only asthma, only COPD, and asthma + COPD, respectively. With respect to the patients with asthma who also had asthma + COPD, the OR of asthma + COPD was 5.272 in underweight patients and 6.479 in patients aged ≥70 years. Meanwhile, a high association between COPD and asthma + COPD was found in female patients, whereas asthma was more highly associated with asthma + COPD in male patients. CONCLUSION: The study confirmed that old age, sex, smoking status, BMI, previous history of atopic dermatitis, and lung cancer were independent risk factors for asthma, COPD, and asthma + COPD. The present study demonstrated the need for a multidisciplinary integrative approach to respiratory diseases, and the findings could be used for developing policies for the treatment of COVID-19 and respiratory diseases and the prevention of infectious diseases.

The Role of Older Adults in 2- and 3-Generation Households: Implications for Diet Quality and Household Food Security

Food insecurity rates have declined overall (pre-COVID), but have increased significantly among older adults in the past decade. The majority of older adults in the U.S. also have suboptimal diet quality. An older adult's household role may influence their diet quality and the household's food security status, especially in mixed-generation households, but this hypothesis has yet to be tested.To explore the relationships between an older adult's household role, the household's food security status, and the older adult's diet quality in mixed-generation households.A cross-sectional analysis of a nationally-representative sample of U.S. households with at least 1 older adult (age 60+ years) from the 2011-2016 NHANES was conducted (n = 8,136). Households were categorized as: older adult as head of household and child caregiver (ie, child(ren) present, but no adults 18-59 years, HHC), head of household, but not a caregiver (HHNC), and neither head of household nor caregiver (ie, reference person < 60 years, NHNC). The U.S. Household Food Security Survey and Healthy Eating Index-2015 (HEI-2015) from a single dietary recall were used to assess food security status and diet quality, respectively.Weighted chi-square and ANOVA tests were used to compare food security status and HEI-2015 scores across household categories, respectively.HHNC households were significantly more likely to be fully food secure (84% FFS, P < 0.001) than HHC households (67% FFS) and NHNC households (68% FFS). Older adults as HHNC had significantly higher HEI-2015 scores (mean: 53.7, P < 0.001) than HHC older adults (50.2) and NHNC older adults (51.5).Findings suggest that caregiving demands may have a negative influence on food security and diet quality of older adults in mixed generation households. While such relationships have potential bearing on nutrition programming and policy, further research is needed to understand the underlying household dynamics, including more advanced analyses to account for potential covariates (eg, the number and age of children and roles of other household members).

Mental health of Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) and the associated social distancing, limited freedom, and fear of an uncertain future are expected to have substantial mental health effects. We investigated mental health responses in the community during the first year of the COVID-19 pandemic in Korea. METHODS: We used 2016-2019 and 2020 data from the Korea National Health and Nutrition Examination Survey (KNHANES) to assess pre-pandemic and pandemic mental health status, respectively, in terms of perceived severe stress, depression, and suicidal plans. All analyses were gender-stratified. Pre-specified subgroup analyses were performed according to age, employment status, and household income. RESULTS: The percentage of Korean adults with suicidal plans increased significantly from 1.3%p (95% confidence interval [CI], 1.1 to 1.5) in 2016-2019 to 1.8%p (95% CI, 1.4 to 2.1) in 2020. Individuals in their 20s and 40s showed a marked increase in suicidal plans (1.2%p; 95% CI, 0.0 to 2.3 and 0.9%p; 95% CI, 0.0 to 1.8, respectively). In men, depression and perceived severe stress increased significantly from pre-COVID-19 to 2020. There was a 2.4%p (95% CI, 0.8 to 4.0) increase in depression among standard workers and a 2.9%p increase in depression in individuals in the second-highest quintile of household income from 2016 and 2018 to 2020. CONCLUSIONS: As COVID-19 continued, mental health issues such as suicidal plans, depression, and severe stress increased significantly in young men and people in the second-highest quintile of household income. Proactive community mental health efforts are needed to prevent increases in the suicide rate resulting from prolonged exposure to the COVID-19 pandemic.

Obesity, hypertension, diabetes mellitus, and hypercholesterolemia in Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey.

OBJECTIVES: We investigated trends in obesity, hypertension, diabetes, and hypercholesterolemia before and during the coronavirus disease 2019 (COVID-19) pandemic in the Korean adult population. METHODS: Data from 60,098 participants in the Korea National Health and Nutritional Examination Survey between 2011 and 2020 aged ≥19 were used. The age-standardized prevalence and annual percent changes (APCs) were calculated for obesity (body mass index ≥25 kg/m2), hypertension (systolic/diastolic blood pressure ≥140/90 mmHg or under treatment), diabetes (hemoglobin A1c ≥6.5%, fasting glucose ≥126 mg/dL, physician diagnosis, or under treatment), and hypercholesterolemia (total cholesterol ≥240 mg/dL or under treatment). RESULTS: Over the past decade (2011-2020), the age-standardized APCs (95% confidence intervals) for obesity, hypertension, diabetes and hypercholesterolemia were 3.0% (2.1 to 3.8), 0.1% (-1.3 to 1.5), 1.5% (-1.0 to 4.0) and 8.0% (5.7 to 10.3), respectively, in men; and -0.2% (-1.5 to 1.2), -0.5% (-1.9 to 0.9), -0.1% (-2.3 to 2.2) and 5.9% (3.9 to 8.0), respectively, in women. In 2020 compared to the previous 3 years (2017-2019), obesity, hypertension, diabetes, and hypercholesterolemia increased in men (6.0, 1.8, 1.9, and 2.8%p, respectively), but an increase was not apparent in women (2.5, -1.1, 0.8, and 0.7%p, respectively). CONCLUSIONS: An increase in major chronic diseases was observed in Korean adults, especially men, during the COVID-19 pandemic. In order to reduce the burden of cardiovascular and metabolic diseases in the future, effective intervention strategies need to be developed according to the characteristics of the target groups.

Disparities in human papillomavirus vaccination coverage in the United States, National Health and Nutrition Examination Survey, January 2017-March 2020.

BACKGROUND: We assessed disparities in HPV vaccination coverage by sociodemographic characteristics in the United States. METHODS: Using 2017-March 2020 National Health and Nutrition Examination Survey data, we estimated vaccination coverage of ≥ 1 dose of HPV vaccine by race/ethnicity and poverty, insurance, and nativity status for females and males aged 9-14, 15-19, and 20-29 years. RESULTS: Among those aged 9-14 years, coverage among non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) females (40.0%, 33.6%, 34.0%) and males (27.1%, 35.3%, 30.9%) was higher than non-Hispanic White (NHW) females (26.5%) and males (25.2%). Among those aged 15-19 and 20-29 years, coverage varied among NHB, Hispanic, and NHA compared to NHW females and was lower among NHB, Hispanic, and NHA than NHW males. Coverage was lower among uninsured than insured in most comparisons. CONCLUSIONS: HPV vaccination coverage varied by race/ethnicity and other characteristics. Efforts are needed to increase HPV vaccination coverage in all populations.

The neutrophil percentage-to-albumin ratio is related to the occurrence of diabetic retinopathy.

BACKGROUND: Among patients with diabetic retinopathy (DR), no proof was available to confirm the prognostic significance of the neutrophil percentage-to-albumin ratio (NPAR). We hypothesized that NPAR plays a role in the incidence of DR in diabetic patients. METHODS: We extracted all diabetes mellitus (DM) data from the National Health and Nutrition Examination Survey (NHANES) database between 1999 and 2018, NPAR was expressed as neutrophil percentage/albumin. Multivariable logistic regression and generalized additive model were utilized for the purpose of examining the correction between NPAR levels and DR. Subgroup analysis of the associations between NPAR and DR was carried out to investigate if the impact of the NPAR varied among different subgroups. RESULTS: An aggregate of 5850 eligible participants were included in the present research. The relationship between NPAR levels and DR was positive linear. In the multivariate analysis, following the adjustment for confounders (gender, white blood cell, age, monocyte percent, red cell distribution width, eosinophils percent, bicarbonate, body mass index, iron, glucose, basophils percent, total bilirubin, creatinine, and chloride), higher NPAR was an independent risk factor for DR compared to lower NPAR (OR, 95% CI: 1.18, 1.00-1.39; 1.24, 1.04-1.48). For the purpose of sensitivity analysis, we found a trend of consistency (p for trend: 0.0190). The results of the subgroup analysis revealed that NPAR did not exert any statistically significant interactions with any of the other DR risk variables. CONCLUSIONS: Elevated NPAR is associated with an elevated risk of occurrence of DR in diabetic patients.

Proteinuria as a Nascent Predictor of Frailty Among People With Metabolic Syndrome: A Retrospective Observational Study.

Frailty is a commonly occurring geriatric condition that increases the risk of adverse health outcomes. The factors and predictors behind frailty are not yet well understood. A better understanding of these factors can enable prevention of frailty in elderly patients. The objective of this study was to determine the association between proteinuria and frailty in US individuals with metabolic syndrome (MetS). Data from the National Health and Nutrition Examination Survey III (NHANES III, 1988-1994) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. This is a cross-sectional study, and proteinuria and frailty were measured only once at enrollment. The study included 2,272 participants with MetS aged 40-90 years from the NHANES III. The participants underwent assessments to evaluate frailty and frailty components (low body weight, weakness, exhaustion, low physical activity, and slow walking). Proteinuria was represented as albumin-to-creatinine ratio (ACR) (mg/g) and divided into tertiles: T1-normal range (ACR <30 mg/g), T2-microalbuminuria (ACR 30-299 mg/g), and T3-macroalbuminuria (ACR ≥ 300 mg/g). We applied multiple logistic regression to determine the odds ratios (ORs) of frailty for T2 vs. T1 and T3 vs. T1 in both sexes. In the adjusted analysis for male participants, the ORs of frailty for T2 and T3 vs. T1 were 3.106 (95% confidence interval [CI] = 1.078-8.948, P = 0.036) and 14.428 (95% CI = 4.231-49.193, P < 0.001), respectively. For female participants, the ORs of frailty for T2 and T3 vs. T1 were 1.811 (95% CI = 1.071-3.063, P = 0.027) and 2.926 (95% CI = 1.202-7.124, P = 0.018), respectively. The positive association between T2 and T3 vs. T1, and frailty were statistically significant. The trends of higher likelihood of every frailty component were also statistically significant across increasing tertiles of proteinuria after multiple levels of adjustment for covariates (P < 0.05). Increased proteinuria levels were positively associated with frailty and each frailty component. Proteinuria might be a useful maker for frailty in individuals with MetS.

Using Machine Learning and the National Health and Nutrition Examination Survey to Classify Individuals With Hearing Loss.

Even before the COVID-19 pandemic, there was mounting interest in remote testing solutions for audiology. The ultimate goal of such work was to improve access to hearing healthcare for individuals that might be unable or reluctant to seek audiological help in a clinic. In 2015, Diane Van Tasell patented a method for measuring an audiogram when the precise signal level was unknown (patent US 8,968,209 B2). In this method, the slope between pure-tone thresholds measured at 2 and 4 kHz is calculated and combined with questionnaire information in order to reconstruct the most likely audiograms from a database of options. An approach like the Van Tasell method is desirable because it is quick and feasible to do in a patient's home where exact stimulus levels are unknown. The goal of the present study was to use machine learning to assess the effectiveness of such audiogram-estimation methods. The National Health and Nutrition Examination Survey (NHANES), a database of audiologic and demographic information, was used to train and test several machine learning algorithms. Overall, 9,256 cases were analyzed. Audiometric data were classified using the Wisconsin Age-Related Hearing Impairment Classification Scale (WARHICS), a method that places hearing loss into one of eight categories. Of the algorithms tested, a random forest machine learning algorithm provided the best fit with only a few variables: the slope between 2 and 4 kHz; gender; age; military experience; and self-reported hearing ability. Using this method, 54.79% of the individuals were correctly classified, 34.40% were predicted to have a milder loss than measured, and 10.82% were predicted to have a more severe loss than measured. Although accuracy was low, it is unlikely audibility would be severely affected if classifications were used to apply gains. Based on audibility calculations, underamplification still provided sufficient gain to achieve ~95% correct (Speech Intelligibility Index ≥ 0.45) for sentence materials for 88% of individuals. Fewer than 1% of individuals were overamplified by 10 dB for any audiometric frequency. Given these results, this method presents a promising direction toward remote assessment; however, further refinement is needed before use in clinical fittings.

Severity of COVID-19 in hospitalized patients with and without atopic disease.

BACKGROUND: Data from the 2009 influenza pandemic suggested asthma might protect from severe disease in hospitalized patients. Asthma does not appear to increase risk for hospitalization or mortality with COVID-19. OBJECTIVE: This study was undertaken to see if atopy actually protected those hospitalized with COVID-19. METHODS: Retrospective chart review on all patients testing positive for SARS-CoV-2 over 2 months at a major adult and pediatric tertiary referral center hospital. Charts were evaluated for history of atopic disease, as were the need for ICU admission, requirement for supplemental oxygen and/or intubation, and in hospital mortality. RESULTS: No significant differences in outcomes for patients (n = 275) based on atopic disease were noted: ICU admission, 43% versus 44.7% (atopic versus no atopic disease, respectively; p = 0.84); supplemental oxygen use, 79.1% versus 73.6% (p = 0.36); intubation rate, 35.8% versus 36.5% (p = 0.92); and mortality rate, 13.4% versus 20.7% (p = 0.19). More patients with atopic disease had COPD listed as a diagnosis in their chart (38.8% versus 17.3%, p < 0.001). COPD was associated with an increased rate of ICU admission (aOR = 2.22 (1.15, 4.30) p = 0.02) and intubation (aOR = 2.05 (1.07, 3.92) p = 0.03). After adjusting for COPD, patients with atopic disease had a trend for reduced mortality (aOR 0.55 (0.23, 1.28), p = 0.16), but those with asthma did not (p > 0.2). CONCLUSION: Severity of COVID-19 in hospitalized patients does not differ based on atopic status. However, adjusting for presence of COPD led to a suggestion of possible reduced severity in patients with atopy but not asthma.