Lung function, 25-hydroxyvitamin D concentrations and mortality in US adults.

OBJECTIVE: To explore the associations between serum concentrations of vitamin D (25(OH)D) and all-cause mortality among US adults defined by lung function (LF) status, particularly among adults with obstructive LF (OLF). METHODS: Data from 10,795 adults aged 20-79 years (685 with restrictive LF (RLF) and 1309 with OLF) who participated in the Third National Health and Nutrition Examination Survey (1988-1994), had a spirometric examination, and were followed through 2006 were included. RESULTS: During 14.2 years of follow-up, 1792 participants died. Mean adjusted concentrations of 25(OH)D were 75.0 nmol/l (s.e. 0.7) for adults with normal LF (NLF), 70.4 nmol/l (s.e. 1.8) for adults with RLF, 75.5 nmol/l (s.e. 1.5) for adults with mild obstruction and 71.0 nmol/l (s.e. 1.9) among adults with moderate or worse obstruction (P=0.030). After adjustment for sociodemographic factors, lifestyle factors, clinical variables and prevalent chronic conditions, a concentration of <25 nmol/l compared with ⩾ 75 nmol//l was associated with mortality only among adults with NLF (hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.03, 3.00). Among participants with OLF, adjusted HRs were 0.65 (95% CI 0.29, 1.48), 1.21 (95% CI 0.89, 1.66) and 0.97 (95% CI 0.78, 1.19) among those with concentrations <25, 25-<50 and 50-<75 nmol/l, respectively. CONCLUSIONS: Baseline concentrations of 25(OH)D did not significantly predict mortality among US adults with impaired LF.

Prevalence and risk factors for metabolic syndrome in Medellin and surrounding municipalities, Colombia, 2008-2010.

OBJECTIVE: We assessed the prevalence of and risk factors for metabolic syndrome (MetS) among adults 25-64 years of age from Medellin and surrounding municipalities, Colombia. METHOD: We used 2008-2010 data from the Antioquia STEPwise approach to Surveillance (STEPS), a multi-stage complex cross-sectional survey designed according to World Health Organization guidelines. The revised 2005 International Diabetes Federation definition of MetS was used. RESULTS: There were a total of 3000 participants. Of these, 21.4% had high blood pressure (HBP) and 64% had abdominal obesity (AO). In the subsample with serum data (n = 943), 19.8% had high fasting serum glucose, 43.9% had high triglycerides (HTG), and 56.6% had low HDL cholesterol (L-HDL). Among those with data to define MetS (n = 901), 41% had MetS. Older age was associated with MetS and all components except L-HDL. Female sex [odds ratio (OR) = 2.85, 95% confidence interval (CI): 2.20-3.70], being married (OR = 1.40, CI: 1.09-1.82), and high physical activity (OR = 0.59, CI: 0.39-0.91) were associated with AO, smoking with HTG (OR = 1.76, CI: 1.16-2.67) and L-HDL (OR = 1.67, CI: 1.10-2.51) and rural residence with HBP (OR = 3.42, CI: 1.83-6.37) and L-HDL (OR = 1.18, CI: 1.10-2.51). CONCLUSION: The prevalence of MetS and AO was high in this Colombian region. Targeted strategies for promoting healthy behaviors are needed.

Trends in obesity and abdominal obesity among adults in the United States from 1999-2008.

BACKGROUND AND OBJECTIVE: The United States has experienced a large increase in the prevalence of obesity since the 1970s. Our objective was to describe recent trends in obesity and abdominal obesity among adults in the United States. DESIGN: Trend study of cross-sectional studies. SUBJECTS: We used data from up to 22,872 men and non-pregnant women aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2008. MAIN OUTCOME MEASURES: Main outcome measures are mean body mass index and waist circumference, percentages of obesity and abdominal obesity. Obesity was defined as a body mass index ≥ 30 kg m(-2), and abdominal obesity was defined as a waist circumference ≥ 102 cm in men and ≥ 88 cm in women. RESULTS: In men, the age-adjusted mean body mass index, mean waist circumference, and prevalence of obesity and abdominal obesity were 27.8 kg m(-2), 99.1 cm, and 26.9 and 37.8%, respectively, during 1999-2000 and 28.5 kg m(-2) (P (trend) = 0.001), 100.8 cm (P (trend) = 0.002), and 32.0 (P (trend) = 0.001) and 43.7% (P (trend) = 0.002), respectively, during 2007-2008. In women, the age-adjusted mean body mass index, mean waist circumference, and prevalence of obesity and abdominal obesity were 28.2 kg m(-2), 92.2 cm, and 33.2 and 55.8%, respectively, during 1999-2000 and 28.6 kg m(-2) (P (trend) = 0.181), 94.9 cm (P (trend) = 0.006), and 35.2 (P (trend) = 0.180) and 61.8% (P (trend) = 0.036), respectively, during 2007-2008. Significant linear trends for increasing prevalence of obesity were noted among men with the least and most education. CONCLUSION: Between 1999 and 2008, both obesity and abdominal obesity increased in men, and abdominal obesity increased in women.

Depression and anxiety among US adults: associations with body mass index.

BACKGROUND: Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors. METHODS: We analyzed the data collected from 177,047 participants (aged>or=18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software. RESULTS: The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMI<18.5 kg/m(2)), in women who were overweight (BMI: 25-<30 kg/m(2)) or obese (BMI>or=30 kg/m(2)), and in men who had class III obesity (BMI>or=40 kg/m(2)) than in those with a normal BMI (18.5-<25 kg/m(2)). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMI>or=40 kg/m(2) were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMI<18.5 kg/m(2) were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders. CONCLUSIONS: Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.

Body mass index and headaches: findings from a national sample of US adults.

The objective was to study the cross-sectional association between body mass index (BMI) and the prevalence of severe headaches or migraines in a national sample of US adults. We used data from 7601 men and women aged > or = 20 years who participated in the National Health and Nutrition Examination Survey 1999-2002. The age-adjusted prevalence of severe headaches or migraines during the previous 3 months was 34.0, 18.9, 20.7 and 25.9% among participants with a BMI < 18.5, 18.5 to < 25, 25 to < 30 and > or = 30 kg/m(2), respectively. After adjusting for a variety of covariates in a logistic regression model, those with a BMI < 18.5 kg/m(2)[odds ratio (OR) 2.01; 95% confidence interval (CI) 1.34, 3.02] or > or = 30 kg/m(2 )(OR 1.37; 95% CI 1.09, 1.72) had a significantly elevated OR for having a headache compared with participants with a BMI of 18.5-< 25 kg/m(2). BMI is associated with the prevalence of severe headaches or migraines in a non-linear manner.

Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System.

AIMS: Anxiety disorders may cause substantial impairment in patient functioning and well-being. Little is known about the relationship between diabetes and anxiety. We estimated the prevalence of lifetime diagnosis of anxiety in adults aged > or = 18 years with and without diabetes in the USA. METHODS: We analysed data from the 2006 Behavioral Risk Factor Surveillance System (total, N = 201 575; 20 142 with diabetes; 39.4% men, 77.9% non-Hispanic Whites, 8.1% non-Hispanic Blacks and 7.7% Hispanics; mean age 52.4 years). Diabetes and lifetime diagnosis of anxiety were self-reported. A multivariable log-binomial model was used to estimate prevalence ratios (PR) and associated 95% confidence intervals (CI) of anxiety based on diabetes status. RESULTS: The overall age-adjusted prevalence of lifetime diagnosis of anxiety was 19.5 and 10.9% in people with and without diabetes, respectively. After adjustment for educational level, marital status, employment status, current smoking, leisure-time physical activity and body mass index, people with diabetes had a 20% higher prevalence of lifetime diagnosis of anxiety than those without (PR 1.20; 95% CI 1.12, 1.30). There were no significant differences in the PR by gender (P = 0.06). However, the ratios differed significantly by age (P = 0.04) and by race/ethnicity (P < 0.01), indicating that people aged 18-29 years (PR 1.70; 95% CI 1.19, 2.43) and Hispanics (PR 1.69; 95% CI 1.33, 2.15) had a higher ratio than their counterparts. CONCLUSION: Diabetes was significantly associated with anxiety in adults in this large population-based sample, particularly in Hispanics and young adults.

The pediatric metabolic syndrome.

The metabolic syndrome is a frequent subject of attention, discussion, and debate in medical research, because of its linkages to the growing problem of obesity on the one hand and both diabetes mellitus and cardiovascular disease on the other. It is also the grounds for contention, as respected researchers disagree on its definition and even on its validity as a construct. This clustering of obesity, dyslipidemia, elevated blood pressure, impaired glucose metabolism, and acute phase reactants can be seen in children as well as in adults. There are at least five definitions of adult metabolic syndrome promulgated by different societies and organizations, and as many as 40 different definitions of the syndrome have been used in pediatric studies. In 2007, the International Diabetes Federation published a definition of pediatric metabolic syndrome; whether it unifies the field remains to be seen. In addition, long term cohort studies have furnished data showing that clusters of the factors used to identify metabolic syndrome do predict the presence of type 2 diabetes and cardiovascular disease defined as myocardial infarction, stroke, coronary artery bypass graft, and/or positive angiogram. In addition, longitudinal studies have demonstrated compromised vascular function in young adults with metabolic syndrome, variously defined, as children and adolescents. This review discusses the background and development of the concept of a metabolic syndrome, the inter-relationships among its constitutive elements, the debates surrounding the uses of the concept and possible treatment avenues.

Racial/ethnic variation in hypertension-related lifestyle behaviours among US women with self-reported hypertension.

Healthy lifestyles such as regular physical activity, frequent consumption of fruits and vegetables, weight control/weight loss and limited alcohol consumption are effective and recommended in hypertension control. Using data collected from a total of 131 788 female participants (aged > or = 18 years) of the 2003 Behavioral Risk Factor Surveillance System, we examined the racial/ethnic disparities in hypertension-related lifestyle behaviours in 36 770 US women with self-reported hypertension from five races/ethnicities (non-Hispanic white (29 237), non-Hispanic black (4288), Asian (445), American Indian/Alaska native (553) and Hispanic (2247)). The prevalence of hypertension varied by race/ethnicity, with the highest seen in non-Hispanic black population (36.9 versus 20.2-26.8% in other racial/ethnic groups). Of all hypertensive women, using non-Hispanic white women as the referent, we found that non-Hispanic black (adjusted odds ratio (AOR): 0.65; 95% confidence interval (CI): 0.55-0.77), American Indian/Alaska native (AOR: 0.72; 95% CI: 0.52-1.00) and Hispanic women (AOR: 0.70; 95% CI: 0.57-0.86) were significantly less likely to engage in physical activity at recommended levels; non-Hispanic black women were more likely to consume > or = 8 servings per day of fruits and vegetables (AOR: 1.70; 95% CI: 1.24-2.34), and less likely to report losing weight (AOR: 0.61; 95% CI: 0.53-0.71). In addition, Hispanic hypertensive women were significantly more likely than non-Hispanic white women to receive weight-loss advice (AOR: 1.97; 95% CI: 1.60-2.44). In contrast, non-Hispanic white women were significantly more likely than those from other races/ethnicities to consume alcoholic beverages or engage in binge drinking. Our results demonstrate that race/ethnicity is an independent predictor of lifestyle behaviours related to hypertension control among American women with hypertension.

Haemoglobin A1c, fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels--the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To evaluate haemoglobin A1c (HbA1c), fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels in a nationally representative sample of men and women. METHODS: Using data from 14,664 participants aged 20 yrs and older in The US Third National Health and Nutrition Examination Survey (1988-1994), we examined the relation between the levels of HbA1c, other biomarkers and serum uric acid levels using multivariate linear regressions stratified by gender. RESULTS: The serum uric acid levels increased with increasing serum HbA1c levels up to the category of 6-6.9%, and thereafter decreased with further increasing HbA1c levels (a bell-shaped relation). Compared with a HbA1c level of < 5%, the multivariate differences among women were 26.8 micromol/l for HbA1c of 6-6.9% and -25.6 micromol/l (95% CI -42.8, -8.3) for HbA1c > or = 9%. The corresponding multivariate differences among men were 8.3 micromol/l (95% CI -3.0, 19.6) and -64.8 micromol/l (95% CI -46.0, -84.5), which were both significantly different from those among women (P-values for interaction by sex <0.001). Fasting glucose levels also showed a bell-shaped relation with serum uric acid levels. Individuals with diabetes showed lower serum uric acid levels and the association was larger among men (P-value for interaction, 0.007). Serum uric acid levels increased linearly with increasing fasting serum C-peptide levels, serum insulin levels or insulin resistance (multivariate P-values for trend, <0.001). CONCLUSIONS: Individuals with moderately elevated HbA1c levels (i.e. pre-diabetes) may be at a higher risk of hyperuricaemia and gout, particularly in women, whereas individuals with diabetes or highly elevated HbA1c levels may be at a lower risk of these conditions, particularly in men.

Compliance with physical activity recommendations in US adults with diabetes.

AIMS: To investigate whether US adults with diabetes meet both the national and American Diabetes Association (ADA) recommendations for physical activity compared with people without diabetes, and to examine the trends of this behaviour over time. METHODS: We analysed data from large nationally representative cohorts from the 1996-2005 Behavioral Risk Factor Surveillance System. The number of participants ranged from 98 127 in 1996 to 204,977 in 2005, and the number of people with diabetes ranged from 4379 in 1996 to 13,608 in 2005. Participants were classified by their exercise status and physical activity levels. The age-standardized prevalence of physical activity participation or meeting physical activity recommendations was calculated in people with and without diabetes. RESULTS: People with diabetes participated less in physical activity (63.1-68.9 vs. 71.7-78.3%) and met physical activity recommendations less than people without diabetes (40.2-42.9 vs. 48.0-51.5% for meeting national recommendations and 38.5-41.7 vs. 46.6-49.8% for meeting ADA recommendations). The percentage of people with diabetes who participated in physical activity in the past 10 years or met physical activity recommendations in the past 5 years did not vary, whereas significantly increasing trends were observed in people without diabetes. The odds for adults with diabetes meeting physical activity recommendations were significantly lower than in adults without diabetes even after multivariate adjustment. CONCLUSION: People with diabetes were less likely to meet either national or ADA recommendations for physical activity than people without diabetes. Our results demonstrate the need for more efforts from health-care professionals to promote physical activity in people with diabetes.

Association between leptin and asthma in adults.

BACKGROUND: Leptin, a pro-inflammatory cytokine produced by adipose tissue, has previously been shown to be associated with asthma in children. We hypothesised that high serum leptin concentrations would also be associated with asthma in adults. METHODS: The Third National Health and Nutrition Examination Survey is a cross sectional study that included fasting serum leptin concentrations and self-report of doctor diagnosed asthma. Data were analysed using multivariable logistic regression analysis. RESULTS: Of 5876 participants, those with current asthma had a higher mean unadjusted leptin concentration than those who had never had asthma (geometric mean (SE) 9.2 (0.6) microg/l v 7.6 (0.2) microg/l; p = 0.02). After adjustment for triceps skinfold thickness and other covariates, the association between leptin and asthma appeared stronger in women than in men, and in premenopausal women than in postmenopausal women. Body mass index (BMI) was also associated with current asthma in women, but this association was not significantly affected by adjustment for leptin concentrations. CONCLUSIONS: The results of this large population based study support the hypothesis that leptin is associated with asthma in women. In addition, while BMI also is related to asthma in women, this study does not support the suggestion that leptin contributes significantly to this association.

Associations between concentrations of alpha- and gamma-tocopherol and concentrations of glucose, glycosylated haemoglobin, insulin and C-peptide among US adults.

Our objective was to study the cross-sectional associations between concentrations of alpha- and gamma-tocopherol and concentrations of glucose, glycosylated haemoglobin, insulin and C-peptide among US adults. We used data for 1289 participants without self-reported diabetes who were aged > or =20 years in the National Health and Nutrition Examination Survey 1999-2000. Alpha-tocopherol concentration was inversely associated with glucose concentration (beta per mmol/l=-0.01064, SE 0.00356, P=0.004) after adjusting for age, sex, race or ethnicity, education, smoking status, concentrations of total cholesterol and triacylglycerols, systolic blood pressure, waist circumference, alcohol use, physical activity, time watching television or videos or using a computer, and use of vitamin/mineral/dietary supplements. Among 659 participants who did not report using supplements, this association was no longer significant whereas the concentration of alpha-tocopherol was inversely associated with concentration of C-peptide (beta per mmol/l=-0.01121, SE 0.00497, P=0.024). Gamma-tocopherol concentration was positively associated with concentration of glucose (beta per mmol/l=0.09169, SE 0.02711, P=0.001) and glycosylated haemoglobin (beta per mmol/l=0.04954, SE 0.01284, P<0.001), but not insulin or C-peptide. The relationships between physiologic concentrations of the various forms of vitamin E and measures of glucose intolerance deserve additional investigation.

Healthy Eating Index and C-reactive protein concentration: findings from the National Health and Nutrition Examination Survey III, 1988-1994.

OBJECTIVE: To examine whether diet quality is associated with C-reactive protein concentration. DESIGN: Cross-sectional study using data from the Third National Health and Nutrition Examination Survey (1988-1994). SETTING: Representative sample of the US population. SUBJECTS: A total of 13 811 men and women aged >/=20 y. INTERVENTIONS: We examined the cross-sectional associations between the Healthy Eating Index (HEI), a measure of diet quality according to the Dietary Guidelines for Americans, and serum C-reactive protein concentration. Dietary information was assessed using a 24-h recall. RESULTS: After adjustment for age, sex, race or ethnicity, education, smoking status, cotinine concentration, body mass index, waist-hip-ratio, aspirin use, alcohol use, physical activity level, and energy intake, HEI score was inversely associated with an elevated C-reactive protein concentration in logistic regression analysis (odds ratio per 10 unit change: 0.92; 95th confidence interval (CI): 0.86-0.99). Among the components, only the score for grain consumption was inversely associated with an elevated C-reactive protein concentration. Compared with participants in the lowest quintile of number of servings of grain consumption, the adjusted odds ratios of having an elevated C-reactive protein concentration for participants in the second, third, fourth, and fifth quintiles were 0.87 (95th CI: 0.67, 1.12), 0.85 (95th CI: 0.69, 1.06), 0.79 (95th CI: 0.65, 0.96), and 0.68 (95th CI: 0.52, 0.88), respectively. CONCLUSIONS: Grain consumption may reduce inflammation. Our findings require confirmation.

Body mass index and asthma incidence among USA adults.

The aim of this study was to examine the association between body mass index (BMI) and asthma incidence. Data from the baseline examination conducted during 1971-1975, and the first follow-up conducted during 1982-1984, of the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study (a cohort study) was used. Asthma was self-reported or reported by proxies. BMI was calculated from measured height and weight obtained during the baseline examination. Among 9,456 participants aged 25-74 yrs who were free of asthma at baseline, 317 participants reported a diagnosis of asthma during the follow-up interview. Compared with participants with a BMI of 18.5-<25.0 kg.m(-2), the odds ratio (OR) for those with a BMI of > or =35 kg x m(-2) was 1.87 (95% confidence interval (CI) 1.12-3.13). ORs were similar for males and females. However, only 125 of the 298 participants who recalled a date of onset reported a diagnosis that occurred after their baseline examination. Among this group of participants, BMI was not significantly associated with asthma incidence (OR 1.52, 95% CI 0.62-3.77). In conclusion, although obese people reported more "incident" asthma during follow-up, it remains unclear whether this represents reactivation of previously diagnosed asthma or the onset of new cases, and whether these new cases actually represent true asthma or respiratory symptoms misdiagnosed as asthma.

Obstructive and restrictive lung disease and functional limitation: data from the Third National Health and Nutrition Examination.

OBJECTIVE: To determine functional limitations in adults with obstructive or restrictive lung disease or respiratory symptoms. DESIGN: Cross-sectional study. SUBJECTS: Adult participants in phase 2 of the Third National Health and Nutrition Examination Survey, 1991-94. METHODS: We classified subjects using spirometric criteria into the following mutually exclusive categories using the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the FEV1/FVC ratio and the presence of respiratory symptoms: severe obstruction, moderate obstruction, mild obstruction, respiratory symptoms only, restrictive lung disease and no lung disease. We developed regression models to predict functional limitations (unable to walk a quarter of a mile, unable to lift 10 pounds, needs help with daily activities) that controlled for age, race, sex, education, smoking status, body mass index and comorbid conditions. RESULTS: Severe and moderate obstruction were associated with an increased risk of being unable to walk a quarter of a mile [odds ratio (OR) 8.4, 95% confidence interval (CI) 3.6, 19.9 and OR 2.4, 95% CI 1.4, 4.0]. Restrictive lung disease and the presence of respiratory symptoms in the absence of lung function impairment were also associated with an increased risk of this outcome (OR 2.8, 95% CI 1.4, 5.6 and OR 2.8, 95% CI 2.0, 3.9). Similar results were obtained for the outcomes of being unable to lift 10 pounds or needing help with daily activities. CONCLUSIONS: The presence of obstructive or restrictive lung disease, or respiratory symptoms in the absence of lung function impairment is associated with increased functional impairment.

C-reactive protein concentration and concentrations of blood vitamins, carotenoids, and selenium among United States adults.

OBJECTIVE: To examine the relationships between circulating concentrations of C-reactive protein and concentrations of retinol, retinyl esters, vitamin C, vitamin E, carotenoids, and selenium. DESIGN: Cross-sectional study using National Health and Nutrition Examination Survey III (1988-1994) data. SETTING: United States population. SUBJECTS: Up to 14 519 US noninstitutionalized civilian men and women aged > or=20 y. RESULTS: C-reactive protein concentration (dichotomized at the sex-specific 85th percentile) was inversely and significantly associated with concentrations of retinol, retinyl esters, vitamin C, alpha-carotene, beta-carotene, cryptoxanthin, lutein/zeaxanthin, lycopene, and selenium after adjustment for age, sex, race or ethnicity, education, cotinine concentration, body mass index, leisure-time physical activity, and aspirin use. CONCLUSIONS: These results suggest that the inflammatory process, through the production of reactive oxygen species, may deplete stores of antioxidants. Whether increased consumption of foods rich in antioxidants or supplementation with antioxidants can provide health benefits to people characterized by elevated C-reactive protein concentrations may be worthy of further study.

The continuing epidemics of obesity and diabetes in the United States.

CONTEXT: Recent reports show that obesity and diabetes have increased in the United States in the past decade. OBJECTIVE: To estimate the prevalence of obesity, diabetes, and use of weight control strategies among US adults in 2000. DESIGN, SETTING, AND PARTICIPANTS: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in all states in 2000, with 184 450 adults aged 18 years or older. MAIN OUTCOME MEASURES: Body mass index (BMI), calculated from self-reported weight and height; self-reported diabetes; prevalence of weight loss or maintenance attempts; and weight control strategies used. RESULTS: In 2000, the prevalence of obesity (BMI >/=30 kg/m(2)) was 19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes (8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not engage in any physical activity, and another 28.2% were not regularly active. Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily. Among obese participants who had had a routine checkup during the past year, 42.8% had been advised by a health care professional to lose weight. Among participants trying to lose or maintain weight, 17.5% were following recommendations to eat fewer calories and increase physical activity to more than 150 min/wk. CONCLUSIONS: The prevalence of obesity and diabetes continues to increase among US adults. Interventions are needed to improve physical activity and diet in communities nationwide.

Achieving a healthy lifestyle among United States adults: a long way to go.

OBJECTIVE: The United States population has been advised to engage in various healthy lifestyle factors known to be associated with reduced morbidity and mortality from various chronic conditions. These include not smoking, adequate fruit and vegetable intake, adequate physical activity, and normal body weight. Little is known about the prevalence of United States adults who engage in all four of these behaviors, however. DESIGN: Cross-sectional analysis. SETTING: The third National Health and Nutrition Examination Survey (1988-1994). PARTICIPANTS: 16,176 participants aged > or = 21 years. MAIN OUTCOME MEASURES: Percentage of participants engaging in four healthy lifestyle factors. RESULTS: Overall, 6.8% of the US population engaged in all four healthy lifestyle factors. Women were more likely than men (P = .001), and Whites and participants of "other race or ethnicity" were more likely than African Americans and Mexican Americans to engage in all four healthy lifestyle factors. A significant positive educational gradient was also evident (P for linear trend <.001). The highest percentages of participants engaging in all four lifestyle factors occurred among men (15.8%) and women (18.4%) of "other" race who had at least 13 years of education. The lowest percentages were observed for White men (1.1%) and African-American women (0.9%) with little education. CONCLUSIONS: The small proportion of US adults engaging in four healthy lifestyle factors demonstrates the enormity of the task that awaits the public health community in persuading Americans to adopt a multidimensional healthy lifestyle.

Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study.

OBJECTIVE: Only a few prospective studies have examined the relationship between the frequency of cigarette smoking and the incidence of diabetes mellitus. The purpose of this study was to determine whether greater frequency of cigarette smoking accelerated the development of diabetes mellitus, and whether quitting reversed the effect. METHODS: Data were collected in the Cancer Prevention Study I, a prospective cohort study conducted from 1959 through 1972 by the American Cancer Society where volunteers recruited more than one million acquaintances in 25 US states. From these over one million original participants, 275,190 men and 434,637 women aged > or = 30 years were selected for the primary analysis using predetermined criteria. RESULTS: As smoking increased, the rate of diabetes increased for both men and women. Among those who smoked > or = 2 packs per day at baseline, men had a 45% higher diabetes rate than men who had never smoked; the comparable increase for women was 74%. Quitting smoking reduced the rate of diabetes to that of non-smokers after 5 years in women and after 10 years in men. CONCLUSIONS: A dose-response relationship seems likely between smoking and incidence of diabetes. Smokers who quit may derive substantial benefit from doing so. Confirmation of these observations is needed through additional epidemiological and biological research.

Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System.

OBJECTIVE: To examine the relationship between self-reported body mass index (BMI) and health-related quality of life in the general adult population in the United STATES: RESEARCH METHODS AND PROCEDURES: Using data from 109,076 respondents in the 1996 Behavioral Risk Factor Surveillance System, we examined how self-reported BMI is associated with five health-related quality of life measures developed by the Centers for Disease Control and Prevention for population health surveillance. RESULTS: After adjusting for age, gender, race or ethnicity, educational attainment, employment status, smoking status, and physical activity status, participants with a self-reported BMI of <18.5 kg/m(2) and participants with a self-reported BMI of > or =30 kg/m(2) reported impaired quality of life. Compared with persons with a self-reported BMI of 18.5 to <25 kg/m(2), odds ratios (ORs) of poor or fair self-rated health increased among persons with self-reported BMIs of <18.5 (1.57, 95% confidence interval [CI]: 1.31 to 1.89), 25 to <30 kg/m(2) (1.12, 95% CI: 1.04 to 1.20), 30 to <35 kg/m(2) (1.65, 95% CI: 1.50 to 1.81), 35 to <40 kg/m(2) (2.58, 95% CI: 2.21 to 3.00), and > or =40 kg/m(2) (3.23, 95% CI: 2.63 to 3.95); ORs for reporting > or =14 days of poor physical health during the previous 30 days were 1.44 (95% CI: 1.21 to 1.72), 1.04 (95% CI: 0.96 to 1.14), 1.32 (95% CI: 1.19 to 1.47), 1.80 (95% CI: 1.52 to 2.13), and 2.37 (95% CI: 1.90 to 2.94), respectively; ORs for having > or =14 days of poor mental health during the previous 30 days were 1.18 (95% CI: 0.97 to 1.42), 1.02 (95% CI: 0.95 to 1.11), 1.22 (95% CI: 1.10 to 1.36), 1.68 (95% CI: 1.42 to 1.98), and 1.66 (95% CI: 1.32 to 2.09), respectively. DISCUSSION: In the largest study to date, low and increased self-reported BMI significantly impaired health-related quality of life. Particularly, deviations from normal BMI affected physical functioning more strongly than mental functioning.