Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: A systematic review and meta-analysis.

INTRODUCTION: Renal cell carcinoma (RCC), a type of kidney cancer has biological sex-based differences that play a role in cancer incidence. Specifically, the incidence of urinary system cancers in men is two times greater than in women, while the incidence of genital cancers is three times greater. There is conflicting epidemiologic and limited evidence in the literature to suggest apparent biological sex discrepancy. The primary objective of this review and meta-analysis is to synthesize evidence to understand biological sex disparity in the survival outcomes of RCC following any treatment intervention. METHODS: A three-step search strategy was utilized in this review. We searched MEDLINE, EMBASE and PsycINFO databases for manuscript on biological sex differences in treatment outcomes. Study screening, critical appraisal, and data extraction were executed independently by pairs of reviewers among co-authors. Studies that had any form of treatment modality in the management of RCC were included. Study designs included observational studies in the form of prospective and retrospective studies that utilized cox proportional hazard assumption to conduct survival analysis. The data synthesis was carried out using the R metafor software package (Software version of 1.2.8) and Microsoft Office Excel 2019 package (Microsoft Corporation, USA). The random effects model was estimated using restricted maximum likelihood estimation (REML). Data synthesis included narrative review and meta-analysis. RESULTS: We had 23 eligible studies for this review. On review of the full text, 35 studies were excluded due to irrelevances to measure estimates utilized. Finally, 12 studies were selected for the meta-analysis with a total of n = 21,2453 individuals. Females had a better survival outcome following a treatment intervention for RCC than their male counterpart [Mean effect size = -0.1737 (95 % CI: -0.2524, -0.0949)]. CONCLUSION: Females were more likely to be cancer free than their male counterpart following treatment for RCC. This finding will inform appropriate decision making for stakeholders.

Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: a systematic review protocol.

OBJECTIVE: This systematic review will assess the biological sex disparity in survival outcomes following treatment for renal cell carcinoma and analyze the estimates of biological sex disparity outcomes following supposed or proposed curative treatment. INTRODUCTION: Renal cell carcinoma is a type of kidney cancer. There is a lack of conformity in the literature on the biological sex disparity in survival outcomes after treatment. This review will help inform the decision-making of clinicians, health care administrators, policy makers, public health workers, and pharmaceutical/biotechnology researchers in predicting positive outcomes following treatment. INCLUSION CRITERIA: The review will consider prospective and retrospective studies on any form of treatment for renal cell carcinoma. The Cox proportional hazard assumption will be used to conduct survival analysis. Hazard rates of participants' survivability across biological sex will also be reported. METHODS: A three-step search strategy will be used. First, a limited search of MEDLINE, Embase, and PsycINFO was conducted and text words in the title, abstract, and index terms were analyzed. Second, a search using identified keywords and index terms will be tailored for all included databases. Third, the reference lists of all included reports and articles will be screened to search for additional studies. There will be no language or date restrictions. Papers not written in English but with a professional translated copy will be included. Study screening, critical appraisal, and data extraction will be conducted independently by pairs of reviewers. Data synthesis will include narrative review and meta-analysis, if appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020195721.

Surrogate indexes of insulin resistance and risk of metabolic syndrome in non-Hispanic White, non-Hispanic Black and Mexican American.

AIM: To compare the strength of associations between surrogate indexes of insulin resistance (sIR) and risk of metabolic syndrome (MetS) in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) adults. METHODS: The 2013-2016 US National Health and Nutrition Examination Survey data (n = 3435) were used for this study. The associations between sIR that includes Triglyceride/HDL cholesterol ratio (TG/HDL-C), triglyceride glucose (TG) index, visceral adiposity index (VAI), lipid accumulation product (LAP), TG-body mass index (TG-BMI), and TG-waist circumference (TG-WC) and risk for MetS were determined using the prevalence odds ratio (OR) from the logistic regression analyses. Pseudo-R-squared tests were used to estimate the proportion of variance in MetS accounted for by each sIR. Akaike Information Criterion and Bayesian Information Criterion from the multinomial logistic regression analysis were used to compare models that included each sIR and its components separately as predictors of MetS. Areas under curves (AUC) from the receiver-operating characteristic (ROC) were used to detect their diagnostic capabilities. RESULTS: Compared with other sIR, TG-WC (AUC = 0.899; 95% CI: 0.884-0.913 in NHW) and (AUC = 0.893; 95% CI:0.871-0.915 in NHB), and LAP (AUC = 877; 95% CI: 0.861-0.894 in MA) exhibited the highest diagnostic and predictive accuracy for MetS. Compared with other sIR, TG-WC (OR = 22.8; 95% CI:16.6-31.0 in NHW) and (OR = 22.7; 95% CI:13.1-39.3 in NHB), and LAP (OR = 10.6; 95%:6.6-17.0 in MA) were most significantly associated with increased odds of MetS, adjusting for eGFR, age, marital status, CHD, CHF, income, education, physical activity, alcohol use, smoking and use of cholesterol-lowering medication. CONCLUSIONS: TG-WC in NHW and NHB, and LAP in MA are more powerful than other proxies of IR in predicting MetS. TG-WC and LAP can serve as adjunctive tools for screening for MetS in NHW, NHB, and MA.

Chronic medical conditions based obesity phenotypes: A two-step cluster analysis of a representative sample of obese American adults.

BACKGROUND AND OBJECTIVE: Although obesity is a heterogeneous disease, little is known regarding chronic medical conditions (CMCs) that defines variability in obese populations. The characterization of obese populations using CMCs rather than categorization using BMI alone can advance understanding of obesity. The aims of this study are to phenotype obesity in a large representative sample of non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) obese adults using CMCs, and assess relationship between resulting phenotypes and self-rated health (SRH). METHODS: Sex-specific two-step cluster analysis was used to phenotype obese participants (n = 12,547) to CMC-based clusters. The prevalence of CMCs and lifestyle risk factors in each cluster was assessed. Sex and race/ethnic specific association between cluster membership and SRH was determined using odds ratio (OR) from logistic regression analysis. RESULTS: Distinct subgroups of obese men and women were observed: moderate dyslipidemic healthy young obese men, hypertensive-dyslipidemic middle-age obese men, hypertensive young obese men, hypertensive-dyslipidemic-asthmatic middle-age obese men, and syndemic elderly obese men, healthy young obese women, hypertensive-dyslipidemic middle-age obese women, dyslipidemic young adult obese women, syndemic middle-age obese women, and syndemic elderly obese women. Participants in the more CMCs symptomatic clusters reported high rates of behavioral risk factors and showed significantly greater odds of poor SRH than participants in the less symptomatic clusters. Compared to obese persons who are asymptomatic for CMCs, syndemic elderly obese and women men had much higher increased ORs for poor SRH with values of 3.88 [95% CI = 2.41-6.26], 3.96 [95% CI = 1.86-8.30] and 7.25 [95% CI = 2.41-9.6] for NHW, NHB and MA men, respectively. The corresponding ORs for women are 4.08 [95% CI = 2.71-6.14], 4.01 [95% CI = 2.40-6.69], and 2.62 [95% CI = 1.32-5.19], respectively. CONCLUSION: Obesity treatment and intervention should consider heterogeneity within obese persons and pay greater attention to obesity related co-morbidities and metabolic manifestations.

Effect of marijuana use on cardiovascular and cerebrovascular mortality: A study using the National Health and Nutrition Examination Survey linked mortality file.

Background Reports associate marijuana use with cardiovascular emergencies. Studies relating marijuana use to cardiovascular mortality are scarce. Recent advance towards marijuana use legalization emphasizes the importance of understanding relationships between marijuana use and cardiovascular deaths; the primary ranked mortality. Recreational marijuana is primarily smoked; we hypothesize that like cigarette smoking, marijuana use will be associated with increased cardiovascular mortalities. Design The design of this study was based on a mortality follow-up. Method We linked participants aged 20 years and above, who responded to questions on marijuana use during the 2005 US National Health and Nutrition Examination Survey to data from the 2011 public-use linked mortality file of the National Center for Health Statistics, Centers for Disease Control and Prevention. Only participants eligible for mortality follow-up were included. We conducted Cox proportional hazards regression analyses to estimate hazard ratios for hypertension, heart disease, and cerebrovascular mortality due to marijuana use. We controlled for cigarette smoking and other relevant variables. Results Of the 1213 eligible participants 72.5% were presumed to be alive. The total follow-up time was 19,569 person-years. Adjusted hazard ratios for death from hypertension among marijuana users compared to non-marijuana users was 3.42 (95% confidence interval: 1.20-9.79) and for each year of marijuana use was 1.04 (95% confidence interval: 1.00-1.07). Conclusion From our results, marijuana use may increase the risk for hypertension mortality. Increased duration of marijuana use is associated with increased risk of death from hypertension. Recreational marijuana use potentially has cardiovascular adverse effects which needs further investigation.

A cross-sectional analysis of the association between marijuana and cigarette smoking with metabolic syndrome among adults in the United States.

AIM: To assess the relationship between marijuana use, cigarette smoking and metabolic syndrome among adults in the United States who reported they use marijuana or cigarettes in comparison to non-marijuana and non-cigarette users. METHOD: We conducted multiple logistic regression analyses using data from the 2011-2012 United States National Health and Nutrition Examination Survey to estimate relationships between cardio-metabolic risk factors and increasing years of smoking cigarette or marijuana use. Statistical adjustments were made for both demographic and endogenous factors related to recreational substance use. RESULTS: Each year increase in marijuana use was significantly associated with increased odds of metabolic syndrome (OR=1.05; 95% CI: 1.01, 1.09), and hypertension (OR=1.04; 95% CI: 1.01, 1.07) adjusting for both demographic and endogenous factors related to recreational substance use. Each year increase in cigarette smoking was significantly associated with increased odds of hypertension (OR=1.03; 95% CI: 1.00, 1.06) and hyperglycemia (OR=1.03; 95% CI: 1.01, 1.05) after adjusting for confounders. CONCLUSION: The results of this investigation suggest that increased years of marijuana or cigarette use are important factors in metabolic health; and consequently calls for the need to consider the potential negative effects of marijuana or cigarette for metabolic syndrome and its associated cardio-metabolic risk components.

Abdominal adiposity and family income-to-poverty ratio in American women.

OBJECTIVE: We examined (a) secular changes in abdominal fat accumulation (AFA) and family income-to-poverty ratio (PIR) across race/ethnicity, education and age in Mexican (MA), non-Hispanic Whites (NHW), non-Hispanic Black (NHB), and (b) association between PIR and AFA among American women. METHODS: Data (n = 9787) from 2001-2002 to 2009-2010 NHANES were used. Rates of AFA and poverty by race/ethnic, age and education categories were determined across study time points. Subjects with low and medium PIR values were classified as poor. Linear trends in AFA and PIR were evaluated. Study time-specific odds ratios (OR) from logistic regression models were used to estimate risk of AFA due to low to medium PIR. Statistical adjustments were made for race/ethnicity, education, age, and marital status. RESULTS: Increased trends in low to medium PIR and AFA in MA, NHW, and NHB American women were observed between 2001 and 2010. Poor women had much higher prevalence of AFA compared to richer women. For each of the studied periods, medium and low PIR were each associated with increased odds of AFA. The association between poverty and AFA was weakest in 2001-2002 (OR = 1.49, 95% CI: 1.05-2.11) compared to 2009-2010 (OR = 1.64, 95% CI: 1.21-2.22). Compared to NHW, being of MA and NHB race/ethnicity was also each associated with increased odds of AFA, controlling for other independent variables. CONCLUSIONS: Increase in poverty and AFA, and positive association between decreased PIR and increased odds of AFA were observed in the period between 2001 and 2010 in MA, NHW, and NHB American women. A robust economic policy designed to alleviate poverty may be an important means of reducing the trajectory of AFA in American women.

Metabolic syndrome and impaired health-related quality of life and in non-Hispanic White, non-Hispanic Blacks and Mexican-American Adults.

OBJECTIVE: We examined the relationship between metabolic syndrome (MetS) and impaired health-related quality of life (HRQoL) in non-Hispanic Whites (NHW), non-Hispanic Black (NHB), and Mexican-Americans (MA). METHODS: Data (n=5170) from 2009-2010 NHANES were used. Subjects perceived poor overall health (POH), poor physical health (PPH), and poor mental health (PMH) status in the past 30 days were used as indices of impaired HRQoL. Race/ethnic-specific associations between MetS and indices of HRQoL were determined using prevalence odds ratios (POR) from logistic regression models. Statistical adjustments were made for age, sex, education, marital status, income and smoking. RESULTS: Rates of POH, PPH and PMH in the past 30 days increased linearly with increased number of components of MetS in NHW, NHB and MA. MetS was associated with increased odds of PPH in NHW (POR=2.34; 95% CI=1.73-3.17) and MA (POR=1.65; 95% CI=1.09-2.50); increased odds of PPH in NHW (POR=1.65; 95% CI=1.18-2.31), NHB (POR=1.83; 95% CI=1.01-3.35), and MA (POR=1.67; 95% CI=1.09-2.83); and increased odds of PMH in NHW (POR=1.50; 95% CI=1.08-2.08), NHB (POR=2.28; 95% CI=1.29-4.01), and MA (POR=1.44; 95% CI=0.80-2.59). Upon adjustment for other independent variables, smoking and lack of education were found associated with increased odds of impaired HRQoL. CONCLUSIONS: MetS is associated with POH, PPH, and PMH in American adults. From clinical standpoint, this study further suggests that HRQoL should be considered in the management of subjects with MetS. Robust public health programs designed to reduce the prevalence of MetS may help in reducing impaired HRQoL, including POH, PPH, and PMH in American adults who have MetS.

Awareness of diabetes risks is associated with healthy lifestyle behavior in diabetes free American adults: evidence from a nationally representative sample.

PURPOSE: The purpose of this study was to examine whether diabetes free healthy non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and Mexican-Americans (MA) who are told of their diabetes risk were more likely to adopt healthy lifestyle behavior defined as current weight control, physical activity and reduced fat/calories intake than those who were not told that they were at increased risk. METHODS: A nationally representative data (n=5073) from the 2007-2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Odds ratio from multiple logistic regression analysis was used to determine whether diabetes free NHW, NHB, and MA who are told of their increased diabetes risk were more likely than those who are not told of their diabetes risk to adopt healthy lifestyle behavior. RESULTS: Being told of increased diabetes risk was associated with increased adoption of healthy lifestyle behaviors as indicated by odds ratio of 2.38 (95% CI=1.34-4.05) in NHW, 2.46 (95% CI=1.20-5.05) in NHB and 2.27 (95% CI=1.32-3.89) in MA who have no diabetes, after adjusting for age, sex, race/ethnicity, hypertension, education, household income and total cholesterol. CONCLUSIONS: Awareness of increased risk for diabetes is associated with implementing healthy lifestyle behaviors in diabetes free healthy American adults. Population-based programs designed to assess and communicate diabetes risk may be helpful in preventing or delaying the onset of type 2 diabetes. Programs designed along racial/ethnic line may be needed to reduce racial/ethnic differences in rates of type 2 diabetes.

Translation of the National Institutes of Health Diabetes Prevention Program in African American churches.

OBJECTIVE: To translate the Diabetes Prevention Program (DPP) for delivery in African American churches. METHODS: Two churches participated in a 6-week church-based DPP and 3 churches participated in a 16-week church-based DPP, with follow-up at 6 and 12 months. The primary outcomes were changes in fasting glucose and weight. RESULTS: There were a total of 37 participants; 17 participated in the 6-session program and 20 participated in the 16-session program. Overall, the fasting glucose decreased from 108.1 to 101.7 mg/dL post intervention (p=.037), and this reduction persisted at the 12-month follow-up without any planned maintenance following the intervention. Weight decreased 1.7 kg post intervention with 0.9 kg regained at 12 months. Body mass index (BMI) decreased from 33.2 to 32.6 kg/m2 post intervention with a final mean BMI of 32.9 kg/m2 at the 12-month check (P<.05). Both the 6- and 16-session programs demonstrated similar reductions in glucose and weight; however, the material costs of implementing the modified 6-session DPP were $934.27 compared to $1075.09 for the modified 16-session DPP. CONCLUSION: Translation of DPP can be achieved in at-risk African Americans if research teams build successful community-based relationships with members of African American churches. The 6-session modified DPP was associated with decreased fasting glucose and weight similar to the 16-session program, with lowered material costs for implementation. Further trials are needed to test the costs and effectiveness of church-based DPPs across different at-risk populations.

Continuous metabolic syndrome risk score, body mass index percentile, and leisure time physical activity in American children.

The objective of this study was to determine independent and joint association of body mass index (BMI) percentile and leisure time physical activity (LTPA) with continuous metabolic syndrome (cMetS) risk score in 12- to 17-year-old American children. The 2003 to 2004 US National Health and Nutrition Examination Survey data were used for this investigation. LTPA was determined by self-report. cMetS risk score was calculated using standardized residuals of arterial blood pressure, triglycerides, glucose, waist circumference, and high-density lipoprotein cholesterol. Multiple linear regression analysis was used to evaluate association of BMI percentile and LTPA with cMetS risk score, adjusting for confounders. Increased BMI percentile and LTPA were each associated with increased and decreased cMetS risk score, respectively ((P<.01). There was a gradient of increasing cMetS risk score by BMI percentile cutpoints, from healthy weight (-0.77) to overweight (3.43) and obesity (6.40) ((P<.05). A gradient of decreasing cMetS risk score from sedentary (0.88) to moderate (0.17) and vigorous (-0.42) LTPA levels was also observed (P<.01). The result of this study suggests that promoting LTPA at all levels of weight status may help to reverse the increasing trends of metabolic syndrome in US children.

The effect of urinary cadmium on cardiovascular fitness as measured by VO2 max in white, black and Mexican Americans.

OBJECTIVES: We explored potential effects of cadmium exposure on cardiovascular fitness measures, including gender and racial/ethnic differences. METHODS: Data were from the 1999 to 2000 National Health and Nutrition Examination Survey (NHANES); 1963 participating subjects were included in our analysis. Volume of oxygen consumed at sub-maximum activity (VO(2) max) were recorded in a series of graded exercises; the goal was to elicit 75% of predetermined age-specific heart rates. Cadmium from urine samples was measured in the laboratory using standard methods. Multivariate linear regression analyses were performed to determine potential relationships. RESULTS: Increased urinary cadmium concentrations were generally associated with decreased estimated VO(2) max values. Gender and racial/ethnic differences were also observed. Specifically, associations were statistically significant for white males and Mexican American females. CONCLUSION: Inverse associations between urinary cadmium concentrations and estimated VO(2) max values were observed, including racial and gender differences. The implications of such gender and racial/ethnic differences on long-term cardiovascular health and health disparities of present public health concern warrant further investigation.

Metabolic syndrome and C-reactive protein in American adults: the impact of abdominal obesity.

AIMS: Although elevated C-reactive protein (CRP) and abdominal obesity (AO) are associated with metabolic syndrome, their connection is unclear. The aim of this study was to determine the impact of AO on the association of CRP with metabolic syndrome. METHODS: Data (n = 6270) from the 2005-2006 U.S. National Health and Nutrition Examination Survey were used in this investigation. The impact of AO on the association of CRP with metabolic syndrome was determined using logistic regression analysis. In the regression model, statistical adjustments were made for age, sex, race/ethnicity, alcohol intake, smoking, education, and respiratory and inflammatory diseases. RESULTS: Overall, elevated CRP (odds ratio [OR] = 1.38; 95% confidence interval [CI], 1.10-1.73) and AO (OR = 2.71; 95% CI, 1.93-3.80) were associated with increased odds of metabolic syndrome, adjusting for age, sex, race/ethnicity, alcohol intake, smoking, education, and respiratory and inflammatory diseases. In men, CRP (OR = 1.45; 95% CI, 1.04-2.03) and AO (OR = 2.03; 95% CI, 1.16-3.54) were associated with increased odds of metabolic syndrome. The corresponding values in women were 1.35 (95% CI, 1.05-1.86) and 2.94 (95% CI, 1.91-4.53), respectively. Overall, adjustment for AO was associated with 10.1% reduction in the association of CRP with metabolic syndrome. The analogous values for men and women were 4.8% and 14.1%, respectively. CONCLUSIONS: In multivariate logistic regression analysis, CRP was associated with reduced risk of metabolic syndrome adjusting for AO independently of potential confounders, thus confirming once again the importance of weight reduction for the management of metabolic syndrome. Weight reduction programs or other interventions targeted specifically at abdominal regions may help to alleviate risk of metabolic syndrome.

Diabetes prevention in a faith-based setting: results of translational research.

AIM: The purpose of this study was to translate the National Institutes of Health (NIH)-Diabetes Prevention Program (DPP) into a church-based setting. METHODS: The lifestyle arm of the NIH-DPP was implemented in an African American Baptist church. Church members 18 years or older completed a risk screen during Sunday service followed by fasting glucose (FG) testing at the church during the week. Persons with prediabetes participated in a 16-session DPP conducted over 4 months. Participation rates, height, weight, blood pressure (BP) and FG were followed for 12 months post-intervention. Fifty participants completed the risk screen, 26 were at risk for diabetes, 16 of 26 received FG testing, and 8 had prediabetes (FG = 100- 125 mg/dL). RESULTS: The mean participation rate was 10.4 (65%) sessions. Following the intervention, weight, systolic and diastolic BP, and FG decreased by 7.5 lb (3.6%), 16 mm Hg (11.7%), 12 mm Hg (14.0%), and 5 mg/dL (4.8%), respectively (P < .05). In comparison with baseline, significant reductions were evident at 6 and 12 months postintervention for all endpoints. CONCLUSIONS: This study demonstrated successful translation of the 16-session NIH-DPP into a church-based setting. Future studies should test this intervention in churches of different sizes and denominations.

Self-reported and measured height and weight: impact on racial/ethnic differences in hypertension.

OBJECTIVE: We compare estimability of obesity from self-reported and measured height and weight in White, Black, and Hispanic Americans. We also sought to determine the effect of using self-reported and measured height and weight in determining the association of obesity with risk of hypertension in these population groups. METHODS: The 1999-2000 National Health and Nutrition Examination Survey (NHANES 1999-2000) participants' (n=4789) self-reported and measured height and weight were used for this study. Logistic regression adjusted for age, blood glucose level, total cholesterol level, smoking status, and exercise status to compare the association of obesity estimated from self-reported and measured height and weight on the prevalence odds of hypertension. RESULTS: Men tended to overestimate height and weight, and women tended to overestimate height and underestimate weight. Using self-reported values diminished the prevalence of obesity and odds of hypertension, and this effect related to ethnicity and sex. In men, self-report decreased the prevalence of hypertension by 9.1%, 11.8%, and 26.6% in Whites, Blacks, and Hispanics, respectively. The analogous values in women were 11.1%, 22.7%, and 7.7%. CONCLUSION: Public health researchers and practitioners who use self-reported height and weight should be aware of the potential for error when using self-reported values to estimate obesity so that they may make better decisions regarding obesity screening and prevention.

The effects of a patient-based risk assessment prompt on diabetes screening.

OBJECTIVE: Previous research has determined that nurse-based diabetes risk assessment increases screening and preventive services for patients at risk for type 2 diabetes. This pilot study tested the impact of a diabetes risk assessment completed by patients without nursing assistance. RESEARCH DESIGN AND METHODS: Patients from a family medicine residency clinic completed an American Diabetes Association Risk Assessment questionnaire. Intervention subjects presented completed questionnaires to their physicians. Control subjects returned the questionnaire to the research assistant. Primary endpoints were the number of persons receiving diabetes screening and the number of persons with newly diagnosed diabetes. The associations between the intervention and diabetes screening and diagnosis were assessed using univariate and multivariate logistic regression models. RESULTS: This study included 511 subjects (256 in the intervention group and 255 in the control group). Comparing intervention to control subjects, there was no difference in fasting glucose screening rates. However, odds of diabetes diagnoses were significantly higher using univariate analysis (OR 5.2; 95% CI 1.1-24.3, p=.036) and approached statistical significance after adjusting for other risk factors (OR 4.6; 95% CI 0.92-23.2, p=.063). CONCLUSIONS: A simple patient-based risk assessment used in the outpatient setting may represent a simple, economical method for discovering previously-undiagnosed type 2 diabetes.

Diagnosed diabetes and ethnic disparities in adverse health behaviors of American women.

Despite higher rates of some high-risk lifestyle factors in non-Hispanic black women compared to non-Hispanic white women, no data exist examining the role of diagnosed diseases. Having diabetes diagnosed might motivate women and their providers to work together to lower the women's levels of behavioral risk factors. The purpose of this study was to determine the association between diagnosed diabetes and adverse health behaviors, including smoking, alcohol consumption, and sedentary lifestyle in non-Hispanic white (n=270) and non-Hispanic black (n=149) women with type 2 diabetes. Diagnosed diabetes was defined as answering "yes" to the Third US National Health and Nutrition Examination Survey question: "Have you ever been told by a doctor that you have diabetes or sugar diabetes?" Logistic regression analyses were used to determine the association of diagnosed diabetes with the adverse health behaviors. In this study, non-Hispanic black diabetic women had higher prevalences of smoking, sedentary lifestyle, and lower rates of diagnosed diabetes compared with non-Hispanic white women (P<0.01). Relative to non-Hispanic diabetic white, non-Hispanic diabetic black was associated respectively with 25% and 58% increased odds of smoking and sedentary lifestyle, adjusting for diagnosed diabetes and other confounding variables. Approximately 15% of alcohol consumption and 13% excess sedentary lifestyle in non-Hispanic diabetic blacks were associated with their increased rates of diagnosed diabetes relative to non-Hispanic diabetic whites. These excesses in adverse health behaviors, however, were within what can be explained by chance variation. There were non-significant trends toward less smoking and more sedentary lifestyle. Thus, diabetic women with a diagnosis generally had a worse behavioral risk profile than those without a diagnosis even after controlling multiple confounders. This shows the need for physicians to educate their diabetic patients regarding benefits of exercise and smoking avoidance.

Abdominal obesity and ethnic differences in diabetes awareness, treatment, and glycemic control.

OBJECTIVE: To compare racial/ethnic differences in diabetes awareness, treatment, and glycemic control between non-Hispanic white, non-Hispanic black, and Hispanic Americans. We also determined the impact of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control between these population groups. RESEARCH METHODS AND PROCEDURES: Third National Health and Nutrition Examination Survey (NHANES III) data were utilized for this study. Diabetes awareness was defined as acknowledging diabetic status. Diabetes treatment was defined as current use of anti-diabetic medications, good glycemic control as HbA(1c) < 8%, and abdominal obesity as waist circumference larger than expected. The impacts of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control were assessed using logistic regression analyses. Adjustments were made for age, education, smoking, alcohol intake, and health insurance. RESULTS: Rates of diabetes awareness in whites, blacks, and Hispanics suffering from abdominal obesity were approximately 74%, 30%, and 21% in men and 77%, 32%, and 19% in women, respectively. Rates of diabetes treatment were 70%, 23%, and 14% in men and 57%, 45%, and 23% in women, respectively. In men, rates of glycemic control were 64%, 40%, and 30%, and in women, they were 62%, 51%, and 27%, respectively. Abdominal obesity was associated with decreased diabetes awareness and glycemic control in women. DISCUSSION: Subjects with abdominal obesity were found to have poorer glycemic controls compared to those without abdominal obesity. Because diabetes prevalences were partially explained by racial/ethnic differences in diabetes awareness, treatment, and glycemic control, there is a need to craft diabetes awareness, treatment, and control programs along racial/ethnic origins.

Serum carotenoids and clustering of adverse health behaviors in American adults.

OBJECTIVE: To determine the association between clustering of adverse health behaviors (cigarette smoking, alcohol intake, and sedentarism) and serum carotenoids in a representative sample of white, Black, and Hispanic Americans. METHODS: Data (n=6,218) from the Third US National Health and Nutrition Examination Survey were utilized for this investigation. Adjusted gender-specific linear regression analyses were used. RESULTS: Increase in clustering of adverse health behaviors was associated with decreased serum concentrations of a-carotene, b-carotene, bcryptoxanthine, and luteine/zeaxanthene in the 3 racial/ethnic groups (P<0.05). CONCLUSION: Persons with multiple adverse health behaviors should be advised to increase fruit and vegetable consumption, as primary sources of chemopreventive antioxidants.