The effect of vitamin D and frailty on mortality among non-institutionalized US older adults.

BACKGROUND/OBJECTIVES: Although both frailty and low vitamin D have been separately associated with an increased risk for adverse health, their joined effects on mortality have not been reported. The current study examined prospectively the effects of frailty and vitamin D status on mortality in US older adults. SUBJECTS/METHODS: Participants aged ≥ 60 years in The Third National Health and Nutrition Examination Survey with 12 years of mortality follow-up were included in the analysis (n=4731). Frailty was defined as meeting three or more criteria and pre-frailty as meeting one or two of the five frailty criteria (low body mass index (BMI), slow walking, weakness, exhaustion and low physical activity). Vitamin D status was assessed by serum 25-hydroxyvitamin D (25(OH)D) and categorized into quartiles. Analyses were adjusted for gender, race, age, smoking, education, latitude and other comorbid conditions. RESULTS: Serum 25(OH)D concentrations were lowest in participants with frailty, intermediate in participants with pre-frailty and highest in participants without frailty. The odds of frailty in the lowest quartile of serum 25(OH)D was 1.94 times the odds in the highest quartile (95% confidence interval (CI): 1.09-3.44). Mortality was positively associated with frailty, with the risk among participants who were frail and had low serum 25(OH)D being significantly higher than those who were not frail and who had high concentrations of serum 25(OH)D (hazards ratio 2.98; 95% CI: 2.01-4.42). CONCLUSION: Our results suggest that low serum 25(OH)D is associated with frailty, and there is additive joint effects of serum 25(OH)D and frailty on all-cause mortality in older adults.

Body mass index and mortality rate among Hispanic adults: a pooled analysis of multiple epidemiologic data sets.

OBJECTIVE: To evaluate the association between body mass index (BMI, kg m⁻²) and mortality rate among Hispanic adults. METHODS AND PROCEDURES: Analysis of five data sets (total N=16,798) identified after searching for publicly available, prospective cohort data sets containing relevant information for at least 500 Hispanic respondents (≥18 years at baseline), at least 5 years of mortality follow-up, and measured height and weight. Data sets included the third National Health and Nutrition Examination Survey, the Puerto Rico Heart Health Program (PRHHP), the Hispanic Established Population for Epidemiologic Studies of the Elderly (HEPESE), the San Antonio Heart Study (SAHS) and the Sacramento Area Latino Study on Aging. RESULTS: Cox proportional hazards regression models, adjusting for sex and smoking, were fit within three attained-age strata (18 to younger than 60 years, 60 to younger than 70 years, and 70 years and older). We found that underweight was associated with elevated mortality rate for all age groups in the PRHHP (hazard ratios [HRs]=1.38-1.60) and the SAHS (HRs=1.88-2.51). Overweight (HRs=0.38 and 0.84) and obesity grade 2-3 (HRs=0.75 and 0.60) associated with reduced mortality rate in the HEPESE dataset for those in the 60 to younger than 70 years, and 70 years and older attained-age strata. Weighted estimates combining the HRs across the data sets revealed a similar pattern. CONCLUSION: Among Hispanic adults, there was no clear evidence that overweight and obesity associate with elevated mortality rate.

Coffee intake and risk of incident diabetes in Puerto Rican men: results from the Puerto Rico Heart Health Program.

OBJECTIVE: To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35-79 years). METHODS: Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used to assess the association of coffee intake with risk of incident diabetes while adjusting for covariates (age, BMI, physical activity, smoking, education, alcohol intake, family history of diabetes, intakes of milk and sugar). RESULTS: Five hundred and nineteen participants met the criteria for incident diabetes. Compared with those reporting intake of 1-2 servings of coffee/d, coffee abstainers were at reduced risk (OR = 0.64; 95 % CI 0.43, 0.94). Among coffee drinkers, there was a significant trend of decreasing risk by intake (P = 0.02); intake of >/=4 servings/d was associated with an odds ratio of 0.75 (95 % CI 0.58, 0.97). CONCLUSIONS: Study findings support a protective effect of coffee intake on diabetes risk, while also suggesting that abstainers may be at reduced risk.

Physical activity in a cohort of HIV-positive and HIV-negative injection drug users.

Physical activity is beneficial for persons with HIV infection but little is known about the relationships between physical activity, HIV treatment and injection drug use (IDU). This study compared physical activity levels between HIV-negative and HIV-positive injection drug users (IDUs) and between HIV-positive participants not on any treatment and participants on highly active antiretroviral therapy (HAART). Anthropometric measurements were obtained and an interviewer-administered modified Paffenbarger physical activity questionnaire was administered to 324 participants in a sub-study of the AIDS Linked to Intravenous Experiences (ALIVE) cohort, an ongoing study of HIV-negative and HIV-positive IDUs. Generalized linear models were used to obtain univariate means and to adjust for confounding (age, gender, employment and recent IDU). Vigorous activity was lower among HAART participants than HIV-positive participants not on treatment (p=0.0025) and somewhat lower than HIV-negative participants (p=0.11). Injection drug use and viral load were not associated with vigorous activity. Energy expenditure in vigorous activity was also lower among HAART participants than both HIV-negative and HIV-positive participants not on treatment. Thus, HIV-positive participants on HAART spend less time on vigorous activity independent of recent IDU. More research is needed into the reasons and mechanism for the lack of vigorous activities, including behavioral, psychological and physiological reasons.

Acculturation and leisure-time physical inactivity in Mexican American adults: results from NHANES III, 1988-1994.

OBJECTIVES: This study examined the relationship between acculturation and leisure-time physical inactivity among Mexican American adults. METHODS: Using data from the Third National Health and Nutrition Examination Survey, we estimated the prevalence of physical inactivity according to place of birth and language used at home. RESULTS: Spanish-speaking Mexican Americans had a higher prevalence of physical inactivity during leisure time than those who spoke mostly English, independent of place of birth. CONCLUSIONS: Acculturation seems to be positively associated with participation in leisure-time physical activity.

Dietary intake and nutritional status of US adult marijuana users: results from the Third National Health and Nutrition Examination Survey.

OBJECTIVES: This study examined dietary intakes and nutritional status of marijuana users and non-current marijuana users in US adults aged 20 to 59 years. METHODS: We used data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994. Information on self-reported drug use, including marijuana, was obtained as part of the NHANES III physical examination component. Nutritional status was assessed using height and weight, and blood biochemistries. Dietary intake was assessed using a 24-hour recall and a food-frequency questionnaire. RESULTS: Among adults 20-59 years of age, 45% reported ever having used marijuana in their lifetime. A total of 8.7% reported using marijuana in the past month. Current marijuana users had higher intakes of energy and nutrients than non-current marijuana users; however, body mass index (BMI) was slightly lower. We found higher cigarette-smoking rates and higher consumption of sodas and alcohol, specifically beer, among marijuana users than among non-current marijuana users. Marijuana users also consumed more sodium, fewer fruits, and more pork, cheese, and salty snacks. Nutritional status, using indicators of serum nutrients, serum albumin, haematocrit and haemoglobin, was similar between marijuana users and non-current marijuana users. Serum carotenoid levels were lower among marijuana users, independent of cigarette smoking. CONCLUSION: Dietary intake was different among marijuana users than among non-current marijuana users. Although overall nutritional status was similar, serum carotenoid levels were lower in marijuana users. The long-term health effects of these differences in marijuana users deserve careful consideration in future research.

Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988-1994.

OBJECTIVES: To examine the relationship between television watching, energy intake, physical activity, and obesity status in US boys and girls, aged 8 to 16 years. METHODS: We used a nationally representative cross-sectional survey with an in-person interview and a medical examination, which included measurements of height and weight, daily hours of television watching, weekly participation in physical activity, and a dietary interview. Between 1988 and 1994, the Third National Health and Nutrition Examination Survey collected data on 4069 children. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. RESULTS: The prevalence of obesity is lowest among children watching 1 or fewer hours of television a day, and highest among those watching 4 or more hours of television a day. Girls engaged in less physical activity and consumed fewer joules per day than boys. A higher percentage of non-Hispanic white boys reported participating in physical activity 5 or more times per week than any other race/ethnic and sex group. Television watching was positively associated with obesity among girls, even after controlling for age, race/ethnicity, family income, weekly physical activity, and energy intake. CONCLUSIONS: As the prevalence of overweight increases, the need to reduce sedentary behaviors and to promote a more active lifestyle becomes essential. Clinicians and public health interventionists should encourage active lifestyles to balance the energy intake of children.

Modifiable and nonmodifiable factors associated with osteoporosis in postmenopausal women: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

We wished to study the relationship between modifiable and nonmodifiable factors that were correlated with osteoporosis using a national sample of women aged 50 years and older who have never been on hormone replacement therapy (HRT). We used a cross-sectional study design with a nationally representative sample with a detailed clinical examination and a home interview. Between 1988 and 1994, 1953 postmenopausal women who had never been on HRT, aged 50 years and older, were examined as part of the Third National Health and Nutrition Examination Survey (NHANES III). Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. Bone density measurements of four proximal femur sites were assessed by using x-ray absorptiometry (DEXA). A DEXA measurement at any single femur site indicated osteoporosis if it was >2.5 standard deviations (SD) below the reference mean of 20--29-year-old women. The study demonstrated that numerous factors, both modifiable and nonmodifiable, were significantly related to the prevalence of osteoporosis. The modifiable factors identified were participation in physical activity (three to five times per week) and body mass index (BMI). Nonmodifiable factors included age, race, and mother's history. With the aging population, osteoporosis is a growing concern for the medical community. It is suggested that educational strategies are needed to increase awareness of factors that contribute to maintaining bone health among postmenopausal women. Emphasis may be placed on maintaining regular physical activity.

Neurobehavioral test performance in the third National Health and Nutrition Examination Survey.

The third National Health and Nutrition Examination Survey (NHANES III) contained three computerized neurobehavioral tests from the Neurobehavioral Evaluation System (NES): simple reaction time, symbol-digit substitution and serial digit learning. The neurobehavioral data that were collected came from a nationally representative sample of adults 20-59 years old. Performance on the tests was related to sex, age, education level, family income and race-ethnicity. Performance decreased as age increased, and increased as education level and family income increased. Differences in performance between sexes, levels of education and racial-ethnic groups tended to decrease as family income increased. The relationship between age and performance on the symbol-digit substitution test varied by education level and by racial-ethnic group. The relationship between age and performance on the serial digit learning test varied by racial-ethnic group. Questionnaire variables that were related to performance on one or more of the tests included the reported amount of last night's sleep, energy level, computer or video game familiarity, alcoholic beverages within the last 3 h and effort. Persons who took the tests in English or Spanish performed differently on the symbol-digit substitution and serial digit learning tests. Performance on all the tests decreased as test room temperature increased.

Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: Physical inactivity is more prevalent among racial and ethnic minorities than among Caucasians. It is not known if differences in participation in leisure time physical activity are due to differences in social class. Thus, this paper provides estimates of the prevalence of physical inactivity during leisure time and its relationship to race/ethnicity and social class. METHODS: This was a national representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 18,885 adults aged 20 or older responded to the household adult and family questionnaires as part of the Third National Health and Nutrition Examination Survey . Mexican-Americans and African-Americans were over-sampled to produce reliable estimates for these groups. Multiple assessment of social class included education, family income, occupation, poverty status, employment status, and marital status. RESULTS: The age-adjusted prevalence (per 100) of adults reporting leisure time inactivity is lower among Caucasians (18%) than among African-Americans (35%) and Mexican-Americans (40%). African-American and Mexican-American men and women reported higher prevalence of leisure time inactivity than their Caucasian counterparts across almost every variable, including education, family income, occupation, employment, poverty and marital status. CONCLUSIONS: Current indicators of social class do not seem to explain the higher prevalence of physical inactivity during leisure time among African-American and Mexican-American. More research is needed to examine the effect of other constructs of social class such as acculturation, safety, social support and environmental barriers in promoting successful interventions to increase physical activity in these populations.

Encouraging physical activity in minorities: eliminating disparities by 2010.

Healthy People 2000 and Healthy People 2010 are programs designed to measure and encourage physical activity for all Americans, regardless of race, ethnic group, or economic status. The objective of these programs is to reduce and eliminate disparity between population groups in terms of promoting health and preventing illness, disability, and death. Physicians need to consider the unique needs and constraints of minority patients when giving advice and prescribing exercise regimens. Some patients, for example, might do best in community-sponsored recreational activities.

Prevalence of significant knee pain among older Americans: results from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To assess the prevalence of persistent knee pain among older adults in the US. DESIGN: A nationally representative cross-sectional survey with an in-person interview and medical examination SETTING AND PARTICIPANTS: Between 1988 and 1994, 6596 adults aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were over-sampled to produce reliable estimates for these groups. MAIN OUTCOME MEASUREMENTS: Participants were asked to report whether they had experienced knee pain on most days for the 6 weeks preceding their medical exam. RESULTS: Overall, 18.1% of US men and 23.5% of US women aged 60 years and older reported knee pain. Sixty- to ninety-year-old men reported knee pain less frequently than their age-matched female counterparts. There was a trend for reports of knee pain to increase steadily as these adults aged from 60 to 85 years. The highest prevalence of knee pain was reported among 85- to 90-year-old men (23.7%) and women (30.0%). Among non-Hispanic white adults older than age 60, 18.4% of men and 22.0% of women reported knee pain. Reports of knee pain among non-Hispanic black men and Mexican American men were similar to those of their non-Hispanic white counterparts. In contrast, 26.4% of Mexican American women and 32.8% of non-Hispanic black women reported knee pain. We also found that difficulty in performing physical functioning activities was associated with a higher prevalence of knee pain. CONCLUSIONS: Many US adults older than age 60 years report knee pain, and the prevalence is higher in older adults. Reports of knee pain are highest among non-Hispanic black women and the oldest Americans. Intervention strategies are needed to prevent and better manage knee pain among older US adults to stem the adverse health consequences and diminished quality of life associated with this common problem.

Prevalence of physical inactivity and its relation to social class in U.S. adults: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

PURPOSE: This study examines the prevalence of physical inactivity during leisure time in a national representative sample of U.S. adults. METHODS: Data were obtained from the Third National Health and Nutrition Examination Survey, conducted between 1988 and 1994. A total of 18,825 adults aged 20 yr and older participated in a home interview where information about physical activity, education, income, occupation, employment, and labor force participation was obtained. RESULTS: The prevalence of physical inactivity among U.S. adults was 23%, with more women (28%) than men (17%) reporting being inactive during their leisure time. Additionally, inactivity is more common among in social class such as persons who are less educated, living below the poverty line, living in households with income below 20,000 dollars, and who are retired. In every category of social class, women experienced a higher prevalence of physical inactivity than men. CONCLUSIONS: We conclude that social class is associated with physical inactivity and that more research is needed to better understand the effect that other social and environmental factors have on sedentary behaviors in our society.

Estimates of animal and plant protein intake in US adults: results from the Third National Health and Nutrition Examination Survey, 1988-1991.

OBJECTIVE: To describe the sources of protein intake in a sample of the US adult population and among subgroups defined by race-ethnicity, age, and gender. DESIGN: The Third National Health and Nutrition Examination Survey, 1988-1991, is a stratified random sample of the total civilian noninstitutionalized population, drawn from the 50 United States and the District of Columbia. For all foods consumed by the participants, based on a 24-hour dietary recall, protein sources and the contribution of each protein type to the total protein intake were determined. SUBJECTS: Adult participants in the third National Health and Nutrition Examination Survey (n = 7,924). STATISTICAL ANALYSES: Weighted total, age-specific, and age-adjusted mean protein intakes were calculated using SAS and WesVarPC. Statistical differences were determined by 2-tailed t tests. RESULTS: The main protein source in the American diet is animal protein (69%). Meat, fish, and poultry protein combined contributed the most to animal protein (42%), followed by dairy protein (20%). Grains (18%) contributed the most to plant protein consumption. Women consumed a lower percentage of beef (14%) and pork (7%) protein than did men (18% and 9%, respectively). Women also consumed a higher percentage of poultry (13%), dairy (22%), and fruit and vegetable (11%) protein than did men (11%, 19%, and 9%, respectively). Blacks reported eating a higher percentage of poultry (18%) and pork (11%) protein and a lower percent of dairy protein (14%) than did whites (12%, 7%, and 22%, respectively) and Mexican-Americans (11%, 8%, and 17%, respectively). Mexican-Americans consumed a higher percentage of legume (7%) and egg (7%) protein than did whites (4% and 4%, respectively) and blacks (4% and 5%, respectively). Whites consumed a higher percentage of grain protein (19%) than did blacks (16%) and Mexican-Americans (15%). CONCLUSIONS: These results show that, although the percentage of total energy from protein may be similar among race-ethnicities and between men and women, their sources of protein are different. These differences should be taken into account when providing nutrition education for specific populations.

Blood cholesterol and apolipoprotein B levels in relation to intakes of animal and plant proteins in US adults.

Few studies have examined the association between specific sources of protein and blood lipids in a national sample of adults. We examined this relationship in a sample of adults 20 years and older who participated in phase 1 (1988-91) of the Third National Health and Nutrition Examination Survey, a representative sample of the United States non-institutionalized population. After excluding those participants who reported having been told they had high blood cholesterol concentrations, the final sample size was 6228. Mean intakes of different sources of proteins, as a percentage of total protein, were compared in quartiles of blood lipids. Intakes were adjusted for age, sex and race. Additional adjustments were made for other dietary variables, recall day, BMI, smoking, and income. We observed a lower percentage meat, fish and poultry (MFP) protein intake, including a lower percentage of beef and pork protein, among persons in the lowest quartile of serum total cholesterol and apolipoprotein B (ApoB) concentrations than among persons in the higher quartiles. The percentage of plant protein intake was higher in the lowest quartile than in the highest quartile of serum cholesterol. We also observed a higher percentage of fruit protein intake with lower serum cholesterol and ApoB concentrations. We conclude that in this cross-sectional sample, consumption of MFP proteins was consistently higher among persons with higher cholesterol concentrations while consumption of plant proteins was consistently higher among persons with lower cholesterol concentrations. Our findings support the importance of assessing intake of specific protein sources, especially in studies that address dietary intake in relation to blood lipids.

Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey.

CONTEXT: Physical inactivity contributes to weight gain in adults, but whether this relationship is true for children of different ethnic groups is not well established. OBJECTIVE: To assess participation in vigorous activity and television watching habits and their relationship to body weight and fatness in US children. DESIGN: Nationally representative cross-sectional survey with an in-person interview and medical examination. SETTING AND PARTICIPANTS: Between 1988 and 1994, 4063 children aged 8 through 16 years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. MAIN OUTCOME MEASURES: Episodes of weekly vigorous activity and daily hours of television watched, and their relationship to body mass index and body fatness. RESULTS: Eighty percent of US children reported performing 3 or more bouts of vigorous activity each week. This rate was lower in non-Hispanic black and Mexican American girls (69% and 73%, respectively). Twenty percent of US children participated in 2 or fewer bouts of vigorous activity perweek, and the rate was higher in girls (26%) than in boys (17%). Overall, 26% of US children watched 4 or more hours of television per day and 67% watched at least 2 hours per day. Non-Hispanic black children had the highest rates of watching 4 or more hours of television per day (42%). Boys and girls who watch 4 or more hours of television each day had greater body fat (P<.001) and had a greater body mass index (P<.001) than those who watched less than 2 hours per day. CONCLUSIONS: Many US children watch a great deal of television and are inadequately vigorously active. Vigorous activity levels are lowest among girls, non-Hispanic blacks, and Mexican Americans. Intervention strategies to promote lifelong physical activity among US children are needed to stem the adverse health consequences of inactivity.

Leisure-time physical activity among US adults. Results from the Third National Health and Nutrition Examination Survey.

BACKGROUND: The prevalence of no leisure-time physical activity (LTPA) among US adults is estimated to be between 24% and 30%. Such information, however, usually does not include prevalence estimates for non-Hispanic blacks, Mexican Americans, and the elderly. OBJECTIVE: To assess the prevalence of participation in leisure-time physical activity among US adults. METHODS: Between 1988 and 1991, 9488 adults aged 20 years and older were interviewed in their home as part of the third National Health and Nutrition Examination Survey. A clinic examination in a mobile center was also included. Mexican Americans, non-Hispanic blacks, and the elderly were oversampled to produce reliable estimates for these groups. Questions were asked about the type and frequency of physically active hobbies, sports, and exercises. RESULTS: The prevalence of no LTPA for US adults aged 20 years or older from 1988 through 1991 was 22%. The rate was higher in women (27%) than in men (17%). Mexican-American men (33%) and women (46%) and non-Hispanic black women (40%) had the highest rates of no LTPA. Participation in moderate to vigorous LTPA five or more times per week decreased with age, with the largest decreases observed among non-Hispanic black men and women. In almost all subpopulations, gardening and/or yard work and walking were stated as the two top LTPAs of choice. CONCLUSIONS: Many Americans are inactive or irregularly active during their leisure time. Rates of inactivity are greater for women, older persons, non-Hispanic blacks, and Mexican Americans. Intervention strategies meant to promote lifetime physical activities among all Americans represents a major health priority.

Hypertension and other cardiovascular disease risk factors among Mexican Americans, Cuban Americans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey.

DESPITE THEIR HIGHER PREVALENCE of obesity and diabetes, Hispanics have lower or equal rates of hypertension than non-Hispanic whites (1-4). Healthy People 2000 objectives call for increasing the proportion of hypertensive men whose blood pressure is under control to at least 40%. In addition, the objectives recommend reducing the prevalence of overweight to 41% among hypertensive women, and to 35% among hypertensive men (5). The Hispanic Health and Nutrition Examination Survey (HHANES) collected data on Mexican Americans (MA), Cuban Americans (CA), and Puerto Ricans (PR) living in the continental United States. A trained physician measured systolic (SBP) and diastolic (DBP) blood pressure twice in one visit. Our findings provide data to assess baseline estimates for several Healthy People 2000 objectives among Hispanics. Based on criteria from The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V), we found Hispanic women to have higher rates of awareness, treatment, and control of hypertension than men. Only 8% of MA and PR men and 9% of CA men who were hypertensive had their high blood pressure under control. The prevalence of overweight among hypertensive men ranged from 39% to 60%; and among hypertensive women, from 44% to 74%. Hispanic women with six or fewer years of education had higher prevalence of hypertension and other cardiovascular disease (CVD) risk factors. Future research should investigate the socioeconomic factors associated with the presence of these risk factors.