Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes.

INTRODUCTION: People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes. METHODS: We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices. RESULTS: Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes. CONCLUSION: Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Physical Activity Domains/Recommendations and Leukocyte Telomere Length in U.S. Adults.

PURPOSE: The purpose of this study was to examine the associations between different physical activity (PA) domains, PA recommendations, and leukocyte telomere length (LTL) using data from a nationally representative sample of U.S. adults in the National Health and Nutrition Examination Survey, 1999-2002. METHODS: A total of 6933 U.S. adults (3402 men, 3531 women; age range: 20-84 yr) who completed demographic, general health and PA questionnaires and provided a blood sample were included in the analyses. Multivariable-adjusted linear regression models were used to determine associations between PA (domain-specific PA [household/yard work PA, transportation PA, moderate leisure time PA (LTPA), and vigorous LTPA], total moderate PA and PA recommendation groups), and log-transformed LTL adjusting for age, gender, education, cigarette smoking, alcohol consumption, and body mass index. RESULTS: On average, an increase of 1 h·wk of vigorous LTPA was associated with a 0.31% (P < 0.001) longer LTL, and an increase of 1 h·wk of household/yard work PA was associated with a 0.21% (P = 0.03) shorter LTL while adjusted for sociodemographic and health behavior covariates. Neither transportation PA nor moderate LTPA was significantly associated with LTL. In addition, compared with not meeting the PA recommendation (<150 min·wk), exceeding the recommended PA levels (≥300 min·wk) was positively associated with longer LTL (P = 0.04), whereas there was no difference in telomere length between those not meeting versus those meeting the PA recommendation (150-299 min·wk). CONCLUSION: Greater engagement in vigorous LTPA and exceeding the PA recommendation may have a protective effect against telomere shortening. Future studies should examine the association between PA and LTL by exploring potential mediators such as sedentary behavior, genetics, nutrition, and chronic diseases.

Gender differences in physical activity following acute myocardial infarction in adults: A prospective, observational study.

Aims Despite the benefits of regular physical activity participation following acute myocardial infarction, little is known about gender differences in physical activity among patients after acute myocardial infarction. We described, by gender, physical activity trajectories pre- and post-acute myocardial infarction, and determined whether gender was independently associated with physical activity. Methods and results The Variation in Recovery: Role of Gender on Outcomes of Young AMI patients (VIRGO) study, conducted at 103 US, 24 Spanish, and three Australian hospitals, was designed, in part, to evaluate gender differences in lifestyle behaviors following acute myocardial infarction. We used baseline, one-month, and 12-month data collected from patients aged 18-55 years ( n = 3572). Patients were assigned to American Heart Association-defined levels of physical activity. A generalized estimating equation model was used to account for repeated measures within the same individual over time. Men were more active (≥150 min/wk moderate or ≥75 min/wk vigorous activity) than women at baseline (42% vs 34%), one month (45% vs 34%), and 12 months (48% vs 36%) (all p < 0.0001). Men engaged in a significantly longer duration of activity at each time point. When controlling for all other factors, women had 1.37 times the odds of being less active than men from pre-acute myocardial infarction to 12-months post-acute myocardial infarction (95% confidence interval: 1.21-1.55). Non-white race, non-active workplaces, smoking, diabetes, hypertension, and obesity were also associated independently with being less active over time (all p < 0.05). Conclusions Although activity increased modestly over time, women recovering from acute myocardial infarction were less likely to meet physical activity recommendations than were men. By identifying factors associated with low levels of activity during acute myocardial infarction recovery, targeted interventions can be introduced prior to hospital discharge.

Lifestyle Behaviors in Metabolically Healthy and Unhealthy Overweight and Obese Women: A Preliminary Study.

BACKGROUND: Few studies have examined dietary data or objective measures of physical activity (PA) and sedentary behavior among metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Thus, the purpose is to determine whether PA, sedentary behavior and/or diet differ between MHO and MUO in a sample of young women. METHODS: Forty-six overweight/obese (BMI ≥25 kg/m2) African American and Caucasian women 19-35 years were classified by cardiometabolic risk factors, including elevated blood pressure, triglyceride, glucose and C-reactive protein, low high density lipoprotein, and insulin resistance (MUO ≥2; MHO, <2). Time (mins/day) in light, moderate, vigorous PA, and sedentary behavior were estimated using an accelerometer (≥3 days; ≥8 hrs wear time). Questionnaires were used to quantify sitting time, TV/computer use and usual daily activity. The Block Food Frequency Questionnaire assessed dietary food intake. Differences between MHO and MUO for lifestyle behaviors were tested with linear regression (continuous data) or logistic regression (categorical data) after adjusting for age, race, BMI, smoking and accelerometer wear and/or total kilocalories, as appropriate. RESULTS: Women were 26.7±4.7 years, with a mean BMI of 31.1±3.7 kg/m2, and 61% were African American. Compared to MUO (n = 9), MHO (n = 37; 80%) spent less mins/day in sedentary behavior (difference: -58.1±25.5, p = 0.02), more mins/day in light PA (difference: 38.2±16.1, p = 0.02), and had higher daily METs (difference: 0.21±0.09, p = 0.03). MHO had higher fiber intakes (g/day of total fiber, soluble fiber, fruit/vegetable fiber, bean fiber) and daily servings of vegetables; but lower daily dairy servings, saturated fat, monounsaturated fat and trans fats (g/day) compared to MUO. CONCLUSION: Compared to MUO, MHO young women demonstrate healthier lifestyle habits with less sedentary behavior, more time in light PA, and healthier dietary quality for fat type and fiber. Future studies are needed to replicate findings with larger samples that include men and women of diverse race/ethnic groups.

Physical activity and screen time in metabolically healthy obese phenotypes in adolescents and adults.

INTRODUCTION: The purpose of this study was to examine levels of physical activity (PA) and screen time (ST) in metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) adolescents and adults. METHODS: NHANES data from obese adolescents (12-18 years, BMI z-score ≥ 95th percentile) and adults (19-85 years, BMI ≥ 30 kg/m(2)) were pooled from 2003-2005 cycles. Metabolic phenotypes were categorized as MHO (0 or 1 cardiometabolic risk factor; triglycerides, HDL-C, blood pressure, or glucose) or MUO (≥2 cardiometabolic risk factors). Logistic regression models estimated associations between phenotype and PA/ST adjusted for age, gender, BMI, race/ethnicity, menopausal status, and NHANES cycle. RESULTS: Among adolescents, PA was not associated with MHO. In contrast, MHO adults 19-44 years were 85% more likely to engage in active transportation and 2.7 times more likely to be involved in light intensity usual daily activity versus sitting. For each minute per day, adults 45-85 years were 36% more likely to have the MHO phenotype with higher levels of moderate PA. ST was not associated with metabolic phenotypes in adolescents or adults. CONCLUSION: The current study provides evidence that PA, but not ST, differs between MHO and MUO in adults, but not in adolescents. Future studies are needed to confirm results.

Association of metabolic risk with longitudinal physical activity and fitness: coronary artery risk development in young adults (CARDIA).

BACKGROUND: Despite established relationships between physical activity (PA) or physical fitness (fitness) and metabolic risk, the prospective association is not well understood. The purpose of this study was to determine whether metabolic risk in young adults is associated with 20-year PA or fitness trajectories. METHODS: Young adults were from the Coronary Artery Risk Development in Young Adults (CARDIA) study, baseline ages 18-30 years (n=4161). PA was determined from a self-reported questionnaire administered at baseline and at follow-up exams at years 2, 5, 7, 10, 15, and 20. Fitness (seconds) was estimated from a graded exercise treadmill test at baseline and years 7 and 20. Baseline metabolic risk was calculated using age-adjusted principal components analysis (elevated=top 10% of first factor), for each sex-race group, from mean arterial pressure, glucose, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Repeated measures general linear modeling estimated PA and fitness trajectories over 20 years, separately in sex-race groups, adjusting for age and smoking status. RESULTS: PA was significantly lower among those with elevated metabolic risk compared with normal risk at baseline and each subsequent time point (black and white men, white women; all P<0.0001; black women P=0.27). Significant and consistent results were also found with fitness trajectories for all sex-race groups (P<0.0001). Despite these lower PA and fitness levels at baseline in young adults with elevated metabolic compared with normal risk, 20-year trajectories declined at similar rates. CONCLUSION: Elevated metabolic risk is associated with lower levels of PA and fitness in early adulthood, and these differences persist over 20 years.

Total and femoral neck bone mineral density and physical activity in a sample of men and women.

Physical activity (PA), total body fat (TBF), and lean body mass (LBM) are associated with bone mineral density (BMD). However, the independent influence of PA on BMD, while controlling for body composition is not understood as well and is the purpose of the current study. Whole-body BMD (g·cm⁻²), femoral neck BMD (g·cm⁻²), TBF (kg), and LBM (kg) were measured with dual-energy X-ray absorptiometry. PA levels (total, work, sport, non-sport) were estimated using the Baecke questionnaire. General linear models determined the independent effects of PA on BMD (whole-body and femoral neck), with adjustment for age, sex, ethnicity, smoking, menopausal status (as appropriate), LBM, and TBF. These associations were also examined by sex and age group (20-34, 35-49, and 50-64 years). The sample included 802 adults (65% women; 13% African American) from the Pennington Center Longitudinal Study that were 20 to 64 years of age (mean ± SD: 46.9 ± 11.0 years). Higher sports scores were associated with higher femoral neck BMD in the total group, men and women, and in 20- to 34-year-olds and 35- to 49-year-olds, but not significant in those 50-64 years of age. Similar significant associations were found for sports score with total body BMD; however, this relationship was not significant for women or for those 50-64 years of age. Total PA had inconsistent relationships with both femoral neck BMD and total body BMD. Higher levels of sport-related PA are associated with higher femoral neck BMD; however, these relationships vary by PA domain and site of BMD measurement.

A catalog of rules, variables, and definitions applied to accelerometer data in the National Health and Nutrition Examination Survey, 2003-2006.

INTRODUCTION: The National Health and Nutrition Examination Survey (NHANES) included accelerometry in the 2003-2006 data collection cycles. Researchers have used these data since their release in 2007, but the data have not been consistently treated, examined, or reported. The objective of this study was to aggregate data from studies using NHANES accelerometry data and to catalogue study decision rules, derived variables, and cut point definitions to facilitate a more uniform approach to these data. METHODS: We conducted a PubMed search of English-language articles published (or indicated as forthcoming) from January 2007 through December 2011. Our initial search yielded 74 articles, plus 1 article that was not indexed in PubMed. After excluding 21 articles, we extracted and tabulated details on 54 studies to permit comparison among studies. RESULTS: The 54 articles represented various descriptive, methodological, and inferential analyses. Although some decision rules for treating data (eg, criteria for minimal wear-time) were consistently applied, cut point definitions used for accelerometer-derived variables (eg, time spent in various intensities of physical activity) were especially diverse. CONCLUSION: Unique research questions may require equally unique analytical approaches; some inconsistency in approaches must be tolerated if scientific discovery is to be encouraged. This catalog provides a starting point for researchers to consider relevant and/or comparable accelerometer decision rules, derived variables, and cut point definitions for their own research questions.

Characteristics of step-defined physical activity categories in U.S. adults..

PURPOSE: Descriptive physical activity epidemiology of the U.S. population is critical for program development and resource allocation. The purpose of this project was to describe step-defined categories (as measured by accelerometer) of U.S. adults and to determine predictors of sedentary classification (<5000 steps/d). DESIGN: The National Health and Nutrition Examination Survey (NHANES) is an annual, nationally representative survey used to determine the health status of the U.S. populace. SETTING: In-home interviews and physical examination components of NHANES. PARTICIPANTS: Overall, 4372 eligible adults wore accelerometers in the 2005-2006 NHANES; 628 were excluded, which yielded 3744 adults (of which 46.8% were men). MEASURES: Steps per day; body mass index (BMI); demographic, household and behavioral variables. ANALYSIS: Means and frequencies were calculated. Logistic regression was utilized to determine predictors of sedentary classification. RESULTS: Overall, 36.1% were sedentary (i.e., <5000 steps/d); 47.6% were low to somewhat active (5000-9999 steps/d); 16.3% were active to highly active (≥10,000 steps/d). Advancing age (odds ratio [OR], 1.95; confidence intervals [CIs], 1.78, 2.13), higher BMI (OR, 1.40; CIs, 1.23, 1.59), female sex (OR, 1.86; CIs, 1.46, 2.36), African-American versus European-American ethnicity (OR, 1.36; CIs, 1.13, 1.65), household income versus ≥$45,000 (<$25,000: OR, 1.94; CIs, 1.40, 2.69; $25,000-$44,000: OR, 1.51; CIs, 1.23, 1.85), and current versus never smoker (OR, 1.53; CIs, 1.26, 1.86) variables had higher odds of sedentary classification. Usual daily occupational/domestic physical activity categories of standing/walking (OR, .51; CIs, .38, .69); lifting/climbing (OR, .26; CIs, .17, .38); and heavy loads/labor (OR, .16; CIs, .10, .26) had lower odds of sedentary classification than sitting. CONCLUSIONS: Over one-third of the U.S. population was classified as sedentary by accelerometer-determined steps per day, and several characteristics predicted sedentary classification.

Prevalence of cardiometabolic risk factor clustering and body mass index in adolescents.

OBJECTIVE: To establish prevalence of cardiometabolic risk factor clustering within US adolescent body mass index (BMI) groups. STUDY DESIGN: Data were obtained from National Health and Nutrition Examination Survey participants (12-18 years, n = 2457) recruited from 2001-2002, 2003-2004, 2005-2006, and 2007-2008 surveys. Prevalence of risk factor clustering (≥2 risk factors: triglycerides; high-density lipoprotein cholesterol; systolic/diastolic blood pressure; fasting glucose) was determined within Centers for Disease Control-defined BMI groups (normal weight, <85(th) percentile; overweight, 85th to 94th percentile; obese, ≥95th percentile). Logistic regression examined associations of risk factor clustering within BMI groups for sex, race/ethnicity, income, household size, smoking, age, and BMI z-score. RESULTS: Approximately 9%, 21%, and 35% of normal weight, overweight, and obese adolescents had risk factor clustering. Adolescents with risk factor clustering were less likely to be female (OR 95% CI: overweight, 0.33, 0.16-0.68; obese, 0.38, 0.18-0.78) and non-Hispanic black (normal weight, 0.31, 0.17-0.55; overweight, 0.22, 0.07-0.69; obese, 0.24, 0.12-0.50), but more likely to be a smoker (overweight: 4.32, 1.44-12.96), and have a higher BMI z-score (obese, 3.15, 1.29-7.68). Lower income was associated with risk factor clustering in overweight adolescents (0.28, 0.12-0.63), but a higher income was related to risk factor clustering in obese adolescents (1.90, 1.04-3.48). CONCLUSIONS: The prevalence of risk factor clustering increases across adolescent BMI categories; however, associations with sex, race/ethnicity, income, smoking, and BMI vary across groups.

Changes in C-reactive protein from low-fat diet and/or physical activity in men and women with and without metabolic syndrome.

Change in high-sensitivity C-reactive protein (CRP) from low-fat diet (diet) and physical activity (PA) interventions is relatively unknown for adults with metabolic syndrome. The objective of the study was to assess CRP change (DeltaCRP) with diet and/or PA in men and women with and without metabolic syndrome. Men (n = 149) and postmenopausal women (n = 125) with elevated low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol were recruited into a 1-year randomized controlled trial. Treatment groups were as follows: control, diet (reduced total fat, saturated fat, and cholesterol intake), PA (45-60 minutes at 60%-85% maximum heart rate), or diet + PA. Weight loss was not an intervention focus. Metabolic syndrome was defined using the American Heart Association/National Heart, Lung, and Blood Institute criteria. Stored plasma samples were analyzed for CRP. Change in CRP was compared between treatments, within sex and metabolic syndrome status, using analysis of covariance, including covariates for baseline CRP and body fat change. For women with metabolic syndrome (n = 39), DeltaCRP was greater in diet vs control (-1.2 +/- 0.4, P = .009), diet + PA vs control (-1.3 +/- 0.4, P = .006), and diet + PA vs PA (-1.1 +/- 0.4, P = .02). Women with metabolic syndrome receiving the diet component (diet or diet + PA) had greater DeltaCRP compared with those who did not (control or PA) (P = .001). Change in CRP was not significantly different between intervention groups in men overall, women overall, men with (n = 47) or without metabolic syndrome (n = 102), or women without metabolic syndrome (n = 86). Low-fat diet may be the most effective treatment for reducing CRP in women with metabolic syndrome.

Metabolic syndrome and changes in body fat from a low-fat diet and/or exercise randomized controlled trial.

It is difficult to identify the successful component(s) related to changes in metabolic syndrome (MetS) from lifestyle interventions: the weight loss, the behavior change, or the combination. The purpose of this study is to determine the effects of a weight-stable randomized controlled trial of low-fat diet and exercise, alone and in combination, on MetS. Men (n = 179) and postmenopausal women (n = 149) with elevated low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C) were randomized into a 1-year, weight-stable trial with four treatment groups: control (C), diet (D), exercise (E), or diet plus exercise (D+E). MetS was defined using a continuous score. Changes in MetS score (DeltaMetS) were compared between groups using analysis of covariance, stratified by gender and using two models, with and without baseline and change in percent body fat (DeltaBF) as a covariate. In men, DeltaMetS was higher for D vs. C (P = 0.04), D+E vs. C (P = 0.0002), and D+E vs. E (P = 0.02). For women, DeltaMetS was greater for D vs. C (P = 0.045), E vs. C (P = 0.02), and D+E vs. C (P = 0.004). After adjusting for DeltaBF, all differences between groups were attenuated and no longer significant. DeltaMetS were associated with DeltaBF for both men (P < 0.0001) and women (P = 0.004). After adjustment for DeltaBF, low-fat diet alone and in combination with exercise had no effect on MetS. The key component for MetS from low-fat diet and/or increased physical activity appears to be body fat loss.

Leisure time sedentary behavior, occupational/domestic physical activity, and metabolic syndrome in U.S. men and women.

BACKGROUND: This study examines leisure time sedentary behavior (LTSB) and usual occupational/domestic activity (UODA) and their relationship with metabolic syndrome and individual cardiovascular disease (CVD) risk factors, independent of physical activity level. METHODS: National Health and Nutrition Examination Survey (NHANES) 2003-2006 data from men (n = 1868) and women (n = 1688) with fasting measures were classified as having metabolic syndrome by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definition. LTSB was determined from self-reported television viewing and computer usage. UODA was self-reported daily behavior (sitting, standing, walking, carrying loads). RESULTS: LTSB >or=4 hours/day was associated with odds of having metabolic syndrome of 1.94 (95% confidence interval [CI], 1.24, 3.03) in men compared to or=4 hour/day was also associated with higher odds of elevated waist circumference (1.88, CI, 1.03, 3.41), low high-density lipoprotein cholesterol (HDL-C) (1.84, CI, 1.35, 2.51), and high blood pressure (1.55, CI, 1.07, 2.24) in men. LTSB 2-3 hours/day was associated with higher odds of elevated glucose (1.32, CI, 1.00, 1.75) in men. In women, odds of metabolic syndrome were 1.54 (CI, 1.00, 2.37) with >or=4 hours/day LTSB, but LTSB was not associated with risk of the individual CVD risk factors. Higher LTSB was associated with metabolic syndrome in inactive men (1.50, CI, 1.07, 2.09), active men (1.74, CI, 1.11, 2.71), inactive women (1.69, CI, 1.24, 2.33), but not active women (1.62, CI, 0.87,3.01). UODA was not strongly associated with metabolic syndrome or CVD risk factors in either men or women. CONCLUSIONS: In men, high LTSB is associated with higher odds of metabolic syndrome and individual CVD risk factors regardless of meeting physical activity recommendations. In women, high LTSB is associated with higher odds of metabolic syndrome only in those not meeting the physical activity recommendations.