Differences in Hypertension and Stage II Hypertension by Demographic and Risk Factors, Obtained by Two Different Protocols in US Adults: National Health and Nutrition Examination Survey, 2017-2018.

BACKGROUND: To compare prevalence of hypertension and stage II hypertension assessed by 2 blood pressure (BP) observation protocols. METHODS: Participants aged 18 years and older (n = 4,689) in the National Health and Nutrition Examination Survey (NHANES 2017-2018) had their BP measured following 2 protocols: the legacy auscultation protocol (AP) and oscillometric protocol (OP). The order of protocols was randomly assigned. Prevalence estimates for hypertension (BP ≥130/80 mm Hg or use of medication for hypertension) and stage II hypertension (BP ≥140/90 mm Hg) were determined overall, by demographics, and by risk factors for each protocol. Ratios (OP% ÷ AP%) and kappa statistics were calculated. RESULTS: Age-adjusted hypertension prevalence was 44.5% (95% confidence interval [CI]: 41.1%-48.0%) using OP and 45.1% (95% CI: 41.5%-48.7%) using AP, prevalence ratio = 0.99 (95% CI = 0.94-1.04). Age-adjusted stage II hypertension prevalence was 15.8% (95% CI: 13.6%-18.2%) using AP and 17.1% (95% CI: 14.7%-19.7%) using OP, prevalence ratio = 0.92 (95% CI = 0.81-1.04). For both hypertension and stage II hypertension, the prevalence ratios by demographics and by risk factors all included unity in their 95% CI, except for stage II hypertension in adults 60+ years (ratio: 0.88 [95% CI: 0.78-0.98]). Kappa for agreement between protocols for hypertension and stage II hypertension was 0.75 (95% CI = 0.71-0.79) and 0.67 (95% CI = 0.61-0.72), respectively. CONCLUSIONS: In adults and for nearly all subcategories there were no significant differences in prevalence of hypertension and stage II hypertension between protocols, indicating that protocol change may not affect the national prevalence estimates of hypertension and stage II hypertension.

Differences in Hypertension Prevalence and Hypertension Control by Urbanization Among Adults in the United States, 2013-2018.

BACKGROUND: To examine the associations between urbanization and hypertension, stage II hypertension, and hypertension control. METHODS: Data on 16,360 US adults aged 18 years or older from the 2013-2018 National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension (blood pressure (BP) ≥130/80 mm Hg or use of medication for hypertension), stage II hypertension (BP ≥140/90 mm Hg), and hypertension control (BP <130/80 mm Hg among hypertensives) by urbanization, classified by levels of metropolitan statistical areas as large MSAs (population ≥1,000,000), medium to small MSAs (population 50,000-999,999), and non-MSAs (population <50,000). RESULTS: All prevalence ratios (PRs) were compared with large MSAs and adjusted for demographics and risk factors. The PRs of hypertension were 1.07 (95% confidence interval (CI) = 0.99-1.14) for adults residing in medium to small MSAs and 1.06 (95% CI = 0.99-1.13) for adults residing in non-MSAs. For stage II hypertension, the PRs were higher for adults residing in medium to small MSAs 1.21 (95% CI = 1.06-1.36) but not for adults residing in non-MSAs 1.06 (95% CI = 0.88-1.29). For hypertension control, the PRs were 0.96 (95% CI = 0.91-1.01) for adults residing in medium to small MSAs and 1.00 (95% CI = 0.93-1.06) for adults residing in non-MSAs. CONCLUSIONS: Among US adults, urbanization was associated with stage II hypertension.

Developing equations to predict waist circumference measurements based on the National Heart, Lung, and Blood Institute method from the World Health Organization method.

PURPOSE: The purpose of the study was to convert waist circumference (WC) measurements obtained by the World Health Organization (WHO-WC) method to the National Heart, Lung, and Blood Institute (NHLBI-WC) method. METHODS: During 2016, the National Health and Nutrition Examination Survey participants aged 20 years and older had two different WC measurements taken (n = 2405). The mean differences in the WC between the NHLBI-WC and WHO-WC measurements were calculated. Multivariable prediction models were developed to predict the NHLBI-WC from the measured WHO-WC. Sensitivity and specificity of the abdominal obesity classification (AOC) were calculated for the measured WHO-WC and the predicted NHLBI-WC. Kappa coefficients were calculated to evaluate the agreements between the AOC derived from the NHLBI-WC and from the WHO-WC and the predicted NHLBI-WC. RESULTS: The mean differences between the NHLBI-WC and WHO-WC were 0.8 cm for males and 3.2 cm for females (P ≤ .05). Sensitivity of the AOC for the measured WHO-WC was 93% for males and 87% for females, and the specificity of the AOC was 97% or greater for both genders. Sensitivity and specificity of the AOC for the predicted NHLBI-WC were 95% or greater for both genders. The AOC derived from the predicted NHLBI-WC had higher agreements for both genders. CONCLUSIONS: The prediction equations provided may be used to predict the NHLBI-WC from the WHO-WC for comparability in WC estimates across studies.

Contribution of Whole Grains to Total Grains Intake Among Adults Aged 20 and Over: United States, 2013-2016.

Total grains intake comes from whole grains and refined grains. Whole grains contain the entire grain kernel (bran, germ, and endosperm) (1). A higher intake of whole grains is linked with a lower risk of cardiovascular disease, cancer, and mortality (2). The "2015-2020 Dietary Guidelines for Americans" recommend that at least one-half of total grains intake be from whole grains (3). This report provides estimates of the percentage of total grains intake consumed from whole grains sources, for adults aged 20 and over who reported consumption of grains (98.6%) on a given day during 2013-2016.

Waist Circumference Measurement Methodology Study: National Health and Nutrition Examination Survey, 2016.

Objective This report compares five methods of waist circumference (WC) measurements: 1) the National Heart, Lung, and Blood Institute (NHLBI-WC); 2) the World Health Organization (WHO-WC); 3) the Multi-Ethnic Study of Atherosclerosis (MESA-WC) using Gulick II Plus tape; 4) the Multi-Ethnic Study of Atherosclerosis (MESA-WC) using Lufkin tape; and 5) assisted self-measurement over clothes (MESA-assisted). Method During 2016, measurements were obtained from 2,297 participants aged 20 and over, who participated in the National Health and Nutrition Examination Survey (NHANES). The mean differences and sensitivity and specificity for abdominal obesity (AO) were calculated between the NHLBI-WC (reference) and the other four WC measurements. Results The mean difference between NHLBI-WC and WHO-WC was 0.81 cm for men and 3.21 cm for women ( p ≤ 0.0125 for both); between NHLBI-WC and MESA-WC (Gulick) was -0.68 cm for men ( p ≤ 0.0125) and -0.89 cm for women; between NHLBI-WC and MESA-WC (Lufkin) was 0.02 cm for men and 0.08 cm for women; and between NHLBI-WC and MESA-assisted was -0.71 cm for men and 1.34 cm for women ( p ≤ 0.0125 for both). Sensitivity and specificity for AO, with NHLBI-WC as a reference, for men were greater than 90% for all methods; for women, sensitivity and specificity for AO for MESA-WC (Lufkin) were greater than 90%; for women, WHO-WC, MESAWC (Gulick), and MESA-assisted methods were greater than 85%.

Fast Food Consumption Among Adults in the United States, 2013-2016.

Fast food is a part of the American diet and has been associated with high caloric intake (1), and poor diet quality (2). Time, financial resources, price, and availability influence fast food consumption (3). This report presents data on the percentage of adults who consumed fast food on a given day in the United States during 2013-2016.

Mean mid-arm circumference and blood pressure cuff sizes for US children, adolescents and adults: National Health and Nutrition Examination Survey, 2011-2016.

BACKGROUND: Measuring blood pressure (BP) requires an appropriate BP cuff size given measured mid-arm circumference (mid-AC). OBJECTIVE: To provide mid-AC means and percentiles for US population aged more than 3 years and examine the frequency distribution of mid-AC cuffed by Baum and Welch Allyn cuff systems. PATIENTS AND METHODS: The 2011-2016 National Health and Nutrition Examination Survey, a cross-sectional survey, was used to estimate mean mid-AC (n=24 723). RESULTS: Mean mid-AC did not differ from 2011 to 2016 (31.0 vs. 31.3 cm, P>0.05). During 2011-2016, mean mid-AC was greater for males than females (32.0 vs. 30.4 cm, P<0.001) and was largest among adults 40-49 years (34.0 cm). Non-Hispanic Black persons had the largest mean mid-AC (32.0 cm) and non-Hispanic Asian persons the smallest (28.4 cm). Increased BMI was associated with increased mean mid-AC for those 3-19 years (normal, 22.0 cm and obese, 31.5 cm, P<0.001) and more than 20 years (normal, 28.2 cm and obese, 37.8 cm, P<0.001). Among those aged 8-17 years, high BP status was associated with a larger mean mid-AC (normotensive 26.1 cm vs. high BP 28.2 cm, P=0.001). Among adults aged 18 years and older, hypertension status was associated with a larger mean mid-AC (normotensive 32.4 cm vs. hypertensive 34.2 cm, P<0.001). Among those aged 12-19 years, 13.0% required a Baum large cuff (35-46.9 cm mid-AC) and 21.7% required a Welch Allyn large cuff (32-39.9 cm mid-AC). Among those aged more than 20 years, 33.2% required a Baum large cuff, 48.2% required a Welch Allyn large cuff, 1.3% required a Baum extra-large cuff (44-66 cm mid-AC), and 9.5% required a Welch Allyn extra-large cuff (40-55 cm mid-AC). CONCLUSION: Currently, BP is obtained in clinic, pharmacy, home, and ambulatory setting using single or multiple cuffs. National Health and Nutrition Examination Survey mid-AC data should be considered for accurate cuffing avoiding cuff hypertension or hypotension.

Factors Associated With Hypertension Control in US Adults Using 2017 ACC/AHA Guidelines: National Health and Nutrition Examination Survey 1999-2016.

BACKGROUND: Factors and trends associated with hypertension control (BP < 130/80 mm Hg) and mean blood pressure (BP) among hypertensive adults (BP ≥1 30/80 mm Hg or medicated for hypertension). METHOD: Data on 22,911 hypertensive US adults from the 1999-2016 National Health and Nutrition Examination Survey. RESULTS: For men, hypertension control prevalence increased from 8.6% in 1999-2000 to 16.2% in 2003-2004 (P < 0.001), and continued the increasing trend afterwards to 23.2% in 2011-2012 (P < 0.001) and then plateaued. For women, hypertension control prevalence increased from 1999-2000 to 2009-2010 (10.8-26.3%, P < 0.001) and then plateaued. For men with hypertension, systolic BP decreased from 1999-2000 to 2011-2012 (135.7-132.8 mm Hg, P < 0.001) and then increased to 135.3 mm Hg in 2015-2016 (P < 0.001). For women with hypertension, systolic BP decreased from 1999-2000 to 2009-2010 (139.7-131.9 mm Hg; P < 0.001) and then increased to 134.4 mm Hg in 2015-2016 (P = 0.003). Diastolic BP decreased from 1999-2000 to 2015-2016 (men: 79.1-75.5 mm Hg and women: 76.4-73.7 mm Hg, P < 0.001 for both). In 2011-2016, hypertension control was 22.0% for men and 25.2% for women. The adjusted prevalence ratio (PR) of hypertension control were lower for non-Hispanic black men and women (PR = 0.72, 95% confidence interval (CI) = 0.61-0.86; PR = 0.83, 95% CI = 0.70-0.99, respectively; non-Hispanic white (NHW) as reference), Hispanic and non-Hispanic Asian men (PR = 0.70, 95% CI = 0.54-0.92; PR = 0.59, 95% CI = 0.39-0.86; respectively; NHW as reference). CONCLUSION: Hypertension control significantly increased from 1999-2000 to 2011-2012 (men) and 2009-2010 (women) and then plateaued. About a quarter of US adults with hypertension were controlled in 2011-2016.

Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016.

Major depression is a common and treatable mental disorder characterized by changes in mood, and cognitive and physical symptoms over a 2-week period (1). It is associated with high societal costs (2) and greater functional impairment than many other chronic diseases, including diabetes and arthritis (3). Depression rates differ by age, sex, income, and health behaviors (4). This report provides the most recent national estimates of depression among adults. Prevalence of depression is based on scores from the Patient Health Questionnaire (PHQ-9), a symptom-screening questionnaire that allows for criteria-based diagnoses of depressive disorders (5). Estimates for non-Hispanic Asian persons are presented for the first time.

Total, free, and complexed prostate-specific antigen levels among US men, 2007-2010.

BACKGROUND: Screening for prostate cancer using prostate-specific antigen (PSA) is common. Prostate cancer has been associated with higher total PSA (tPSA), lower free PSA (fPSA), lower percent free PSA (%fPSA), and higher complexed PSA (cPSA). METHODS: Total, free and complexed PSAs were performed on 3251 men ≥40years in the 2007-2010 National Health and Nutrition Examination Survey. Distributions of the PSA tests were examined by age, race and ethnicity, and body mass index (BMI) groups. Percentages of men at PSA thresholds were examined. RESULTS: Total PSA geometric mean was 0.96µg/l among men aged ≥40years and increased from 0.74µg/l for men 40-49years, to 1.82µg/l for men 80years and older. Non-Hispanic Whites had lower age-adjusted mean tPSA (1.03µg/l) and cPSA (0.56µg/l) than non-Hispanic Blacks (tPSA 1.25µg/l and cPSA 0.72µg/l). Obese men had lower age-adjusted mean total, free and complexed PSAs (0.94, 0.27, and 0.51µg/l, respectively) than men with normal BMI (tPSA 1.21, fPSA 0.32, and cPSA 0.68µg/l, respectively). CONCLUSION: Total, free and complexed PSAs increased with age; tPSA and cPSAs were highest in non-Hispanic Blacks; and total, free, and complexed PSAs were lowest in obese men.

Validating prediction equations for mid-arm circumference measurements in adults: National Health and Nutrition Examination Survey, 2001-2012.

BACKGROUND: Accurate measurement of blood pressure (BP) requires choosing an appropriate BP cuff size. OBJECTIVES: The objective of this study was to examine the validity of regression equations to predict mid-arm circumference (mid-AC) using 2001-2012 National Health and Nutrition Examination Survey height and weight data. METHODS: National Health and Nutrition Examination Survey uses a complex multistage probability sample design to represent the civilian, noninstitutionalized US resident population. The sample consisted of 29 745 participants aged 20 years and older. RESULTS: For both men and women, the correlations between the predicted and measured mid-AC values were as follows: r=0.91 and 0.92, P<0.001, respectively. For both sexes, the difference between the predicted and measured mid-AC mean values was less than 1.5 cm. The overall percent agreement for selecting the appropriate BP cuff, using the American Heart Association cuff size criteria and comparing the predicted mid-AC values with measured values, was 83.0% for men and 80.0% for women. The percent agreement for small adult cuff was 10.0% for men and 54.0% for women; for adult cuff it was 87.0% for men and 88.0% for women; for large adult cuff it was 82.0% for men and 80.0% for women; and for thigh cuff it was 84.0% for men and 74.0% for women. All agreement statistics were above chance (for men, γ=0.96, and Kendall's Tau-b=0.73; for women, γ=0.97, and Kendall's Tau-b=0.76). CONCLUSION: When possible, mid-AC should be directly measured for appropriate BP cuffing; however, the results of this validation study suggest that the prediction equations for mid-AC estimations were highly correlated and had an overall 80.0% agreement with measured mid-AC.

Perception of weight status in U.S. children and adolescents aged 8-15 years, 2005-2012.

Childhood obesity is a major public health problem associated with many adverse health outcomes in adulthood (1). During 2011­2012, nearly 17% of children and adolescents were obese (2). Weight status misperception occurs when the child's perception of their weight status differs from their actual weight status based on measured height and weight. Accurate weight status self-perception has been linked to appropriate weight control behaviors in youth. The National Health and Nutrition Examination Survey (NHANES) data for children and adolescents aged 8­15 years offers an opportunity to examine weight perception status in this age group.

Urine sodium excretion increased slightly among U.S. adults between 1988 and 2010.

Little information is available on temporal trends in sodium intake in the U.S. population using urine sodium excretion as a biomarker. Our aim was to assess 1988-2010 trends in estimated 24-h urine sodium (24hUNa) excretion among U.S. adults (age 20-59 y) participating in the cross-sectional NHANES. We used subsamples from a 1988-1994 convenience sample, a 2003-2006 one-third random sample, and a 2010 one-third random sample to comply with resource constraints. We estimated 24hUNa excretion from measured sodium concentrations in spot urine samples by use of calibration equations (for men and women) derived from the International Cooperative Study on Salt, Other Factors, and Blood Pressure study. Estimated 24hUNa excretion increased over the 20-y period [1988-1994, 2003-2006, and 2010; means ± SEMs (n): 3160 ± 38.4 mg/d (1249), 3290 ± 29.4 mg/d (1235), and 3290 ± 44.4 mg/d (525), respectively; P-trend = 0.022]. We observed significantly higher mean estimated 24hUNa excretion in each survey period (P < 0.001) for men compared with women (31-33%) and for persons with a higher body mass index (BMI; 32-35% for obese vs. normal weight) or blood pressure (17-26% for hypertensive vs. normal blood pressure). After adjusting for age, sex, and race-ethnicity, temporal trends in mean estimated 24hUNa excretion remained significant (P-trend = 0.004). We observed no temporal trends in mean estimated 24hUNa excretion among BMI subgroups, nor after adjusting for BMI. Although several limitations apply to this analysis (the use of a convenience sample in 1988-1994 and using estimated 24hUNa excretion as a biomarker of sodium intake), these first NHANES data suggest that mean estimated 24hUNa excretion increased slightly in U.S. adults over the past 2 decades, and this increase may be explained by a shift in the distribution of BMI.

Physical activity in U.S. youth aged 12-15 years, 2012.

KEY FINDINGS: Data from the combined National Health and Nutrition Examination Survey (NHANES) and the NHANES National Youth Fitness Survey, 2012. In 2012, about one-quarter of U.S. youth aged 12-15 years engaged in moderate-to-vigorous physical activity for at least 60 minutes daily. Basketball was the most common activity reported among active boys, followed by running, football, bike riding, and walking. Running was the most common activity among active girls, followed by walking, basketball, dancing, and bike riding. The percentage of male youth who were physically active for at least 60 minutes daily decreased as weight status increased. The 2008 Physical Activity Guidelines for Americans, which have been adopted by the First Lady's Let's Move! initiative and the American Academy of Pediatrics, recommend that youth participate in daily moderate-to-vigorous physical activity for at least 60 minutes (1-5). This report presents the most recent national data from 2012 on self-reported physical activity among youth aged 12-15 years, by sex and weight status. This report also describes the most common types of physical activities--outside of school-based physical education (PE) or gym classes--in which youth engage.

Mid-arm circumference and recommended blood pressure cuffs for children and adolescents aged between 3 and 19 years: data from the National Health and Nutrition Examination Survey, 1999-2010.

BACKGROUND: Accurately measuring blood pressure (BP) requires choosing an appropriate BP cuff size. OBJECTIVES: This study examined trends in mid-arm circumference (mid-AC) and in the distribution of appropriate BP cuffs using 1999-2010 National Health and Nutrition Examination Survey (NHANES) data. METHODS: NHANES uses a complex multistage probability sample design to select participants who are representative of the entire civilian, noninstitutionalized US population. The analytic sample consisted of 21 350 participants aged between 3 and 19 years at the time of examination. The mean mid-AC and the percentage of children requiring recommended BP cuff sizes were analyzed across survey years and by sex, age, race/ethnicity, and age-specific and sex-specific BMI categories. RESULTS: During NHANES 1999-2010, the overall trend in mean mid-AC in cm for boys and girls was not significant. During NHANES 2007-2010, 24% of boys aged between 9 and 11 years, 53% of boys aged between 12 and 15 years, and 89% of boys aged between 16 and 19 years required a standard adult cuff or larger to be cuffed correctly. Corresponding estimates for girls were 22, 48, and 57%, respectively. During NHANES 2007-2010, 30.4% of obese boys and 24.3% of obese girls required a large adult cuff and 2.1% of obese boys and 0.9% of obese girls required a thigh cuff for appropriate cuffing. CONCLUSION: During NHANES 2007-2010, 20% of boys and girls as young as 9-11 years required a standard adult cuff to be cuffed appropriately. In addition, approximately one-third of obese participants required adult large BP cuffs to be cuffed appropriately.

Mean mid-arm circumference and blood pressure cuff sizes for U.S. adults: National Health and Nutrition Examination Survey, 1999-2010.

BACKGROUND: Accurately measuring blood pressure (BP) requires choosing an appropriate BP cuff size. OBJECTIVES: This study examined trends in mid-arm circumference (mid-AC) and distribution of BP cuff sizes using 1999-2002, 2003-2006, and 2007-2010 National Health and Nutrition Examination Survey (NHANES) data. METHODS: NHANES uses a complex multistage probability sample design to select participants who are representative of the entire civilian, noninstitutionalized US population. The analytic sample consisted of 28 233 participants aged 20 years or older. Mid-AC and BP cuff sizes were analyzed across survey years by sex, age, race/ethnicity, hypertension, and diabetic status. RESULTS: Data from NHANES 2007-2010 show that the mean mid-AC for men was 34.2 cm and for women was 31.9 cm. Men showed a significant trend in mid-AC (from 33.9 cm in 1999-2002 to 34.2 cm in 2007-2010; P<0.05 for trend). In addition, 42.9% of men and 25.3% of women needed a large adult BP cuff and 1.9% of men and 2.8% of women needed thigh cuffs to be appropriately cuffed. Moreover, 52% of hypertensive men, 38% of hypertensive women, 59.1% of diabetic men, and 53.6% of diabetic women required the use of BP cuffs with sizes different from those of standard adult-sized BP cuffs for accurate BP measurement. CONCLUSION: There was an overall significant trend in the mean mid-AC in cm for men but not for women. On the basis of NHANES 2007-2010 data, ∼45% of adult men and ∼28% of adult women required the use of BP cuffs with sizes different from those of standard adult-sized BP cuffs for accurate BP measurement.

Home blood pressure monitoring and hypertension status among US adults: the National Health and Nutrition Examination Survey (NHANES), 2009-2010.

BACKGROUND: Currently, no national prevalence is available on home blood pressure monitoring (HBPM). METHODS: This report is based on national-level, cross-sectional data for noninstitutionalized US adults aged ≥18 years (n = 6,001 participants) from the National Health and Nutrition Examination Survey (NHANES), 2009-2010. RESULTS: Overall, 21.7% of the population reported HBPM in the past year. Using 2010 Census data as a reference, approximately 33 million (14.5%) individuals engaged in monthly or more frequent HBPM. The frequency of HBPM increased with higher age, higher body mass index, higher family income-to-poverty ratio, and a higher number of health-care visits (all, P < 0.05). Adults with health-care coverage engaged in monthly or more frequent HBPM than adults without coverage (16.1% vs. 8.4%; P < 0.05). Among people with hypertension (blood pressure ≥140/90mm Hg or currently taking medication), 36.6% engaged in monthly or more frequent HBPM. Of those with hypertension whom were aware, treated, and controlled, 41.9%, 43.5%, and 42.1%, respectively, engaged in monthly or more frequent HBPM. Adjusting for covariables, those who were aware of, treated for, and controlled their hypertension were more likely to have a higher frequency of HBPM than the reference: unaware, untreated, and uncontrolled (odds ratio (OR) = 3.59; OR = 3.96; and OR = 1.50, respectively). CONCLUSIONS: Approximately 14.5% of adults engaged in monthly or more frequent HBPM. Being aware of hypertension, being pharmacologically treated, and being controlled were associated with an increased frequency of HBPM. Even among these categories of people with hypertension, <50% were using HBPM.

Physical activity and screen-time viewing among elementary school-aged children in the United States from 2009 to 2010.

OBJECTIVES To describe the percentage of children who met physical activity and screen-time recommendations and to examine demographic differences. Recommendations for school-aged children include 60 minutes of daily moderate-to-vigorous physical activity and no more than 2 hours per day of screen-time viewing. DESIGN Cross-sectional study. SETTING Data from the 2009-2010 National Health and Nutrition Examination Survey, a representative sample of the US population. PARTICIPANTS Analysis included 1218 children 6 to 11 years of age. MAIN EXPOSURES Age, race/ethnicity, sex, income, family structure, and obesity status. MAIN OUTCOME MEASURES Proxy-reported adherence to physical activity and screen-time recommendations, separately and concurrently. RESULTS Based on proxy reports, overall, 70% of children met physical activity recommendations, and 54% met screen-time viewing recommendations. Although Hispanics were less likely to meet physical activity recommendations (adjusted odds ratio [aOR], 0.60 [95% CI, 0.38-0.95]), they were more likely to meet screen-time recommendations compared with non-Hispanic whites (aOR, 1.69 [95% CI, 1.18-2.43]). Only 38% met both recommendations concurrently. Age (9-11 years vs 6-8 years: aOR, 0.57 [95% CI, 0.38-0.85]) and obesity (aOR, 0.53 [95% CI, 0.38-0.73]) were inversely associated with concurrent adherence to both recommendations. CONCLUSIONS Fewer than 4 in 10 children met both physical activity and screen-time recommendations concurrently. The prevalence of sedentary behavior was higher in older children. Low levels of screen-time viewing may not necessarily predict higher levels of physical activity.

Total body bone area, bone mineral content, and bone mineral density for individuals aged 8 years and over: United States, 1999-2006.

OBJECTIVES: This report presents bone measurement data from total body dual energy x-ray absorptiometry scans for 28,454 persons aged 8 years and over who participated in the 1999-2006 National Health and Nutrition Examination Survey. The sample consisted of 22,667 respondents with valid data, and 5,787 with missing data that were successfully multiply imputed (i.e., not highly variable). Bone area, bone mineral content, and bone mineral density (BMD) are presented for the total body, the total body minus the head (e.g., subtotal), and 10 subregions of the body. METHODS: Means, standard deviations, and selected percentiles were calculated for the total body, total body minus head (subtotal), and 10 body subregions by sex, race and ethnicity, and age. Smoothed mean total body BMD was plotted by age, sex, and race and ethnicity. Multiple regression was used to evaluate differences in mean total body BMD by age, sex, and race and ethnicity. RESULTS: After adjusting for race and ethnicity, total body BMD among those under age 20 was significantly higher in respondents aged 12-19 than in those aged 8-11 in both sexes. Among adults of both sexes, total body BMD in persons aged 20-49 was significantly higher than in those aged 50-79, and significantly lower in persons aged 80 and over than in those aged 50-79, after adjusting for race and ethnicity. After adjusting for age, total body BMD was significantly higher in non-Hispanic black persons than in non-Hispanic white persons, regardless of age or sex. However, the pattern differed by age when Mexican-American persons were compared with non-Hispanic white persons: Age-adjusted total body BMD was significantly lower among Mexican-American males aged 8-19, was similar in Mexican-American females aged 8-19, and was significantly lower in Mexican-American men and women aged 20 and over.

Biological variation of hematology tests based on the 1999-2002 National Health and Nutrition Examination Survey.

OBJECTIVE: Biological variation consists of between-person (BP) and within-person (WP) variation. Estimates of WP coefficients of variation (CVw) and BP coefficients of variation (CVg) for hematology laboratory tests were estimated from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). METHODS: NHANES is a survey of the civilian noninstitutionalized U.S. population that uses a stratified, multistage probability design. Between- and within-person variations were estimated for 18 hematology tests. For WP variation, a nonrandom sample was obtained with a median of 17 days between two test measurements. Between-person variation was estimated from the WP sample and additional participants were matched for age group, gender, and race and ethnicity to the WP sample. RESULTS: The BP and WP variations were estimated on as many as 2496 and 852 sample participants, respectively. Mean corpuscular hemoglobin concentration had the lowest CVg (2.25% for men and 2.40% for women), and mean corpuscular volume had the lowest CVw (0.31% for men and 0.37% for women). The index of individuality (CVw/CVg) ranged from 0.06 for mean corpuscular volume for men and women to 0.62 for segmented neutrophil number for men, and 0.55 for segmented neutrophil percent for women. Women had higher CVw compared with men for hematocrit, hemoglobin, mean corpuscular volume, red blood cell count, and red blood cell distribution width. Several hematology tests' CVw also differed by age group, including mean corpuscular volume; eosinophil, lymphocyte and segmented neutrophil percent; monocyte and segmented neutrophil number; white blood cell count; and red blood cell distribution width.