Factors associated with errors in self-reported height and weight in older adults.

OBJECTIVES: Describe the distribution and direction of self-reported versus measured height and weight using variables associated with aging such as cognition, health status, age, and bone mineral density (BMD), and examine the effect of these measurement differences on body mass index (BMI) classification. DESIGN: Data was derived from the third National Health and Nutrition Examination Survey (NHANESIII) conducted from 1988-1994, a nationwide probability sample. PARTICIPANTS: 4,590 non-institutionalized older adults aged 60 and older. MEASUREMENTS: Self-reported and measured height and weight, demographic and lifestyle characteristics, BMD, and subscales from the Mini Mental State Exam were used. Values were considered correct if self-reported height was within one inch of measured height, self-reported weight was within 5 lbs of measured weight, and self-reported BMI was within the same classification as measured BMI. RESULTS: Over-reported height increased with age in both men and women, occurring in 70% of those aged 80 and older. Compared to people with normal BMD, a significantly higher proportion of osteoporotic men (76% versus 47%, P<0.001) and women (52% versus 35%, P<0.001) over-reported their height. Additionally, significant misclassifications of self-reported height and weight occurred among people in poor health and those with poor performances on memory and calculation tests. Nevertheless, there was agreement in BMI classification among almost 80% of the population and among 90% of individuals in the healthy BMI category. CONCLUSION: This study suggests that among an older population, self-reported height and weight may be strongly related to age-associated changes in health status, cognition and BMD.

Vitamin D status and associated factors of deficiency among Jordanian children of preschool age.

BACKGROUND/OBJECTIVES: Vitamin D deficiency in children remains a global concern. Although literature exists on the vitamin D status and its risk factors among children in the Middle East, findings have yielded mixed results, and large, representative community studies are lacking. SUBJECTS/METHODS: In a nationally representative survey of 1077 Jordanian children of preschool age (12-59 months) in Spring 2010, we measured 25(OH)D3 concentrations by liquid chromatography-tandem mass spectrometry and calculated prevalence ratios for deficiency associated with various factors. RESULTS: RESULTS showed 19.8% (95% confidence interval (CI): 16.4-23.3%) deficiency (<12 ng/ml) and 56.5% (95% CI: 52.0-61.0%) insufficiency (<20 ng/ml). In adjusted models, prevalence of deficiency was higher for females compared with males (prevalence ratio (PR)=1.74, 95% CI: 1.22-2.47, P=0.002) and lower for children 24-35 months of age (PR=0.64, 95% CI: 0.44-0.92, P=0.018) compared with children 12-23 months of age. In rural areas, there was no difference in prevalence of vitamin D deficiency between those whose mothers had/did not have vitamin D deficiency (P=0.312); however, in urban areas, prevalence of vitamin D deficiency was 3.18 times greater among those whose mothers were vitamin D deficient compared with those whose mothers were not deficient (P=0.000). CONCLUSIONS: Vitamin D deficiency and insufficiency pose significant public health problems in Jordanian children with female children disproportionately affected. Strong associations between vitamin D status in children and urban residency and maternal vitamin D status suggest that the behaviors related to sun exposure in urban mothers likely also affect the sun exposure and thus vitamin D status of their children.

Seasonal differences in breast-feeding in rural Egypt.

Two surveys in Upper and Lower rural Egypt allowed an analysis of the seasonality of infant feeding. The first, including 937 children, was conducted during the relatively cool season of low diarrhea incidence in January-April 1978; the second, including 976 children, took place during the hot season of high diarrhea incidence in August-September 1980. Of infants 6-11 mo old, the proportion exclusively breast-feeding was greater in the hot-season survey (40% vs 16% in Lower Egypt, p less than 0.01; 36% vs 22% in Upper Egypt, p less than 0.01). Of children 12-17 mo old, a higher proportion were completely weaned during the hot season in Lower Egypt only (28% vs 14%, p less than 0.01). This difference was explained by an increase in pregnancy rates during the hot season resulting in less breast-feeding. Seasonal variation must be considered in the interpretation of infant-feeding surveys.

PIP: 2 surveys in Upper and Lower rural Egypt allowed an analysis of the seasonality of infant feeding. The 1st, including 937 children, was conducted during the relatively cool season of low diarrhea incidence in January-April 1978; the 2nd, including 976 children, took place during the hot season of high diarrhea in August-September 1980. On infants 6-11 mo old, the proportion exclusively breastfeeding was greater in the hot-season survey (40% vs. 16% in Lower Egypt, p0.01; 36% vs 22% in Upper Egypt, p0.01). Of children 12-17 months old, a higher proportion were completely weaned during the hot season in Lower Egypt only (28% vs 14%, p0.01). This difference was explained by an increase in pregnancy rates during the hot season resulting in less breastfeeding. Seasonal variation must be considered in the interpretation of infant-feeding surveys.

Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study.

BACKGROUND: Although body fat patterning has been related to adverse health outcomes in adults, its importance in children and adolescents is less certain. OBJECTIVE: We examined the relation of circumference (waist and hip) and skinfold-thickness (subscapular and triceps) measurements to lipid and insulin concentrations among 2996 children and adolescents aged 5-17 y. DESIGN: This was a community-based, cross-sectional study conducted in 1992-1994. RESULTS: A central or abdominal distribution of body fat was related to adverse concentrations of triacylglycerol, LDL cholesterol, HDL cholesterol, and insulin; these associations were independent of race, sex, age, weight, and height. These associations were observed whether fat patterning was characterized by using 1) waist circumference alone (after adjustment for weight and height), 2) waist-to-hip ratio, or 3) principal components analysis. Compared with a child at the 10th percentile of waist circumference, a child at the 90th percentile was estimated to have, on average, higher concentrations of LDL cholesterol (0.17 mmol/L), triacylglycerol (0.11 mmol/L), and insulin (6 pmol/L) and lower concentrations of HDL cholesterol (-0.07 mmol/L). These differences, which were independent of weight and height, were significant at the 0.001 level and were consistent across race-sex groups. CONCLUSIONS: These findings emphasize the importance of obtaining information on body fat distribution, waist circumference in particular, in children. Waist circumference, which is relatively easy to measure, may help to identify children likely to have adverse concentrations of lipids and insulin.

Evaluation of reactions to food additives: the aspartame experience.

Despite the widespread use of chemical food additives, few criteria exist to evaluate consumer reports of adverse reactions. We analyzed 231 consumer complaints associated with the food additive aspartame. We developed a methodologic approach to evaluate all complaints by adapting general criteria used to investigate adverse reactions to medications. Complaints were ranked according to the effects of cessation and rechallenge. Using this method, we found no clear symptom complex that suggests a widespread public health hazard associated with aspartame use; however, we identified some case reports in which the symptoms may be attributable to aspartame in commonly-consumed amounts. The systematic application of pre-defined review criteria, such as those described here, to monitor consumer complaints related to food additives will help identify products that warrant more focused clinical studies.

Breast-feeding among women attending women, infants, and children clinics in Georgia, 1987.

Breast-feeding is an important determinant of the health and nutritional status of children, particularly in lower socioeconomic populations. A major goal of the Georgia Special Supplemental Food Program for Women, Infants, and Children (WIC) is to increase the practice of breast-feeding among the women it serves. Breast-feeding practices were determined among a random sample of 404 women from a cohort of 2010 who attended WIC prenatal clinics in Georgia in 1986 and were expected to deliver in February 1987. Respondents were interviewed 6 months postpartum. Of these women, 24% initially breast-fed, but only 6% continued for 6 months or longer. The initiation of breast-feeding was associated with greater maternal education and with being married. The adjusted odds of breast-feeding for mothers who were married or living as married were 3.0 (95% confidence interval, 1.7 to 5.3) times greater than for mothers who were not married or living as married. Mothers with more than 12 years, 12 years, or 10 to 11 years of education were 5.2 (1.8 to 15.3), 2.7 (1.0 to 6.9), and 2.5 (0.9 to 6.9) times more likely, respectively, to breast-feed than mothers with 9 or fewer years of education. After adjustment was made for marital status and education, the remaining variables (ethnicity, parity, age, and employment status) did not influence the initiation of breast-feeding in this low-income population. The need for vigorous promotion of breast-feeding by the Georgia WIC program is emphasized by the low rate of initiation and short duration of breast-feeding in this low-income population.

Rubella seroepidemiology in Hawaii.

To determine rubella susceptibility levels 10 years after the introduction of the rubella vaccine in Hawaii, a large-scale serosurvey was conducted in conjunction with a campaign to raise the immunity levels of adolescent and adult women. Each woman tested for rubella antibody was asked her age, ethnic group, migration history, number of siblings, vaccination history, and the occupation of the head of the household. In the period from September 1977 through June 1979, serum specimens acceptable for analysis were collected from 3,852 women; 23.8% were susceptible (haemagglutination inhibition antibody titre less than 8) to rubella. A statistical analysis by fitting log-linear models revealed that rubella vaccination history, birthplace, ethnic group, number of siblings and island of residence appear to be factors related to rubella susceptibility. Although caution must be used in comparing this survey with previous surveys, the relatively low rubella susceptibility rate found in this survey may represent a true decrease in rubella susceptibility due to the rubella vaccination programme.

Secular trends in height among children during 2 decades: The Bogalusa Heart Study.

OBJECTIVE: To examine trends in height among 5- to 17-year-old children between 1973 and 1992. DESIGN: A panel design consisting of 7 cross-sectional surveys. PARTICIPANTS: All schoolchildren residing in Bogalusa, La, were eligible. A total of 24 070 examinations were performed. RESULTS: During the study period, the mean height of schoolchildren increased by 0.70 cm per decade independently of race, sex, and age. Trends were most pronounced among preadolescents, blacks, and boys, with 9- to 12-year-old black boys showing a height increase of 1.8 cm per decade. We observed a decrease in the number of relatively short children (<10th percentile of height) and an increase in the number of tall children (>90th percentile of height). Because a secular trend was not seen among the 15- to 17-year-old children, our findings likely reflect an acceleration of maturation. CONCLUSIONS: It has generally been assumed that secular increases in height among schoolchildren in the United States ceased by the mid-1900s. Our findings, which may be due to various environmental factors, demonstrate that care must be taken when using nonconcurrent reference data to assess the growth of children. Additional study is needed to determine if these secular trends are continuing and to examine possible explanations and consequences of these trends.

Smoking prevalence in the United States and Taipei City, Taiwan.

Although there are extensive antismoking efforts in the United States, smoking is a largely ignored health issue in Taiwan. In fact, tobacco advertising has increased dramatically since U.S. tobacco was first imported in 1987. We compared estimates of smoking prevalence of 83,281 Americans and 5,023 persons in Taipei, Taiwan, in 1986-1988. Among men, current smoking prevalence was higher in Taipei (49%) than in the United States (29%). In contrast, former smoking prevalence among men was substantially lower in Taipei (5%) than in the United States (32%). Young adults and those with lower and middle education levels had the highest smoking prevalence in both surveys. Among women, the current smoking prevalence was only 8% in Taipei, compared to 25% in the United States. The former smoking prevalence among Taipei women (1%) was also lower than among U.S. women (18%). Our findings indicate the need for expanding antismoking efforts in Taiwan, especially among men and among persons with lower and middle education levels.

Correlates of breast-feeding in a low-income population of whites, blacks, and southeast Asians.

Infant feeding was examined in 492 children in a population-based survey conducted in a low-income, urban county of St Paul, Minn. Of 41 Southeast Asian infants who were foreign born, 93% (38) had been breast-fed compared with 10% (12) of Southeast Asian infants born in the United States (n = 116). Among non-Southeast Asian infants, 73% (173) of whites (n = 237), 63% (27) of blacks (n = 43) and 65% (36) of other ethnic groups (n = 55) had been breast-fed. Among the non-Southeast Asian infants, the initiation of breast-feeding was associated with higher parental education and with being married. Ethnic group, level of poverty, and participation in the Supplemental Food Program for Women, Infants, and Children during pregnancy did not appear to influence the initiation of breast-feeding. The findings indicate a higher incidence of breast-feeding than in previous surveys of low-income black and white women; however, this may reflect the higher educational level of the non-Southeast Asian study population. In contrast, the sharp decline in the incidence of breast-feeding among Southeast Asian infants who were born in the United States compared with those who were foreign born indicates the need for public health approaches to strengthen traditional breast-feeding practices.

Premarital rubella screening program: from identification to vaccination of susceptible women in the state of Hawaii.

Premarital rubella screening programs are effective in identifying women of childbearing age who are susceptible to rubella. There is concern, however, that once identified, susceptible women may not be subsequently vaccinated. Therefore, a study was conducted to test the effectiveness of a motivational letter mailed at the time of serologic testing. Rubella-susceptible women identified by a premarital screening program were randomly divided into two groups: one group of 134 received a motivational letter and one group of 143 did not. Three months later, 52 percent of the women in the motivational group had been vaccinated, compared with only 24 percent (P less than 0.05) of the women in the control group. In this study, a motivational letter was found to lead to a significant increase in rubella vaccination rates among susceptible women. With the increasing emphasis on rubella vaccination programs for adult women, active approaches are necessary to identify and vaccinate susceptible women.

Assessing alcohol consumption: beverage-specific versus grouped-beverage questions.

OBJECTIVE: The quantity-frequency method is commonly used to measure alcohol intake in large surveys. Because of time and space constraints, questionnaires are often shortened by combining questions on all types of alcohol into a single question. We investigated the effect of this practice using data from the Behavioral Risk Factor Surveillance System. METHOD: We examined data collected from 213,842 respondents to surveys conducted by 32 states and the District of Columbia participating in the years 1987, 1988, 1989 and 1990. The 1987 and 1988 surveys asked questions about respondents' frequency and level of intake of specific alcohol-containing beverages. The 1989 and 1990 surveys asked about the frequency and quantity of intake of alcohol-containing beverages by combining all beverages into a single group. RESULTS: Among drinkers, the mean number of drinks per month was higher for those who were asked beverage-specific questions than for those who were asked grouped-beverage questions (men: 37.0 vs 29.6; women: 17.0 vs 13.9). CONCLUSION: Caution must be used in comparing level of alcohol intake from surveys in which beverages are not grouped identically.

The association between alcohol use and health behaviors related to the risk of cardiovascular disease: the South Carolina Cardiovascular Disease Prevention Project.

OBJECTIVE: This study examines the relationship between alcohol use and health behaviors related to the risk of cardiovascular disease (CVD). In particular, we examined the relationship between alcohol use and leisure time physical activity, participation in community physical activity programs and behaviors used for weight loss. Numerous studies have found a "protective" effect of moderate alcohol consumption on the risk of CVD. However, most of these studies have not adequately controlled for potential confounding by health behaviors associated with alcohol use. METHOD: We used descriptive and logistic regression analyses to examine cross-sectional survey data from 2,072 participants in the South Carolina Cardiovascular Disease Prevention Project. RESULTS: After controlling for age, race, education and preexisting CVD, moderate and heavy drinkers who do not smoke were more likely than nondrinkers to report engaging in regular leisure time physical activity. The relationship between other health behaviors and alcohol consumption was less clear. Among men, moderate and heavy drinkers were no more likely than nondrinkers to participate in community physical activity programs; among women, moderate and heavy drinkers were more likely than nondrinkers to report this activity. Moderate drinkers were more likely than nondrinkers to report that they were attempting to lose weight, however this difference was not statistically significant. CONCLUSIONS: These data suggest that at least some of the apparent protective effect of moderate alcohol consumption found in other studies may be due to differences between nondrinkers and drinkers with respect to physical activity and other health practices.

Alcohol intake and subsequent mortality: findings from the NHANES I Follow-up Study.

OBJECTIVE: Because past research has focused primarily on populations of middle-aged men, the relationship between alcohol and mortality among women and the elderly has been less well substantiated METHOD: We examined the relationship between alcohol intake and mortality using data from the NHANES I Epidemiologic Follow-Up Study. Total mortality was examined for both sexes (N = 4,614 women, 3,573 men), but ischemic heart disease (IHD) mortality was examined only for men because the number of deaths was too small in women. Proportional hazards modeling was used to adjust for the baseline characteristics of age, race, education, body weight, smoking and physical activity. RESULTS: For men aged 40 to 64, the adjusted relative risks (RR) of death for drinking levels of .5 drinks/day, .5 to < 2 and > or = 2 (compared to the nondrinking reference group) were 0.8 (95% Confidence Interval: 0.6, 1.1), 0.9 (CI:0.6, 1.2) and 1.2 (CI: 0.9, 1.6); RRs of IHD mortality were 0.6 (CI: 0.4, 0.9), 0.5 (CI: 0.3, 0.9) and 0.7 (CI: 0.5, 1.2). For women aged 40 to 64, the RRs for death for the same exposure categories were 1.2 (CI: 0.9, 1.6), 0.9 (CI: 0.6, 1.4) and 1.9 (CI: 1.2, 3.0). Among both sexes 65 years and older, consumption of < 2 drinks/day was associated with about a 20% decrease in total mortality and IHD mortality (men only). However, this protective effect disappeared after exclusion of those with pre-existing disease. CONCLUSIONS: Our findings support a protective effect of moderate alcohol intake on IHD mortality in middle-aged men. Among both men and women, there was little evidence of a protective association between moderate alcohol intake and total mortality after excluding those with pre-existing disease.

The epidemiology of recent involuntary weight loss in the United States population.

BACKGROUND: Although recent involuntary weight loss (RIWL) has been associated with mortality, no national studies described the prevalence among the general population, characteristics and long-term outcomes of people with RIWL. METHODS: The authors analyzed data from the NHANES II Mortality Study of 5838 individuals 50-74.9 years old who between 1976-1980 underwent a physical examination that included height and weight measurements, biochemical tests and responded to questions about involuntary weight loss within the past six months. Vital status was determined through 1992. Logistic regression was used to examine characteristics associated with RIWL and Cox proportional hazard modeling was used to measure associations between RIWL and mortality. RESULTS: 13.3% of the population reported RIWL with 6.9% reporting > or = 5% RIWL. Obese individuals were at significantly higher risk of RIWL of > or = 5% compared to those with BMI 19-24.9 (OR=1.57. 95% CI: 1.13, 2.18). Other significant risk factors for RIWL included; poor self-reported health, cancer, high white blood cell count, low albumin and low hemoglobin levels, age and current smoking status. RIWL of > or = 5% was significantly associated with mortality (RR=1.24, 95% CI: 1.01, 1.53). CONCLUSION: In summary, RIWL is fairly common among community-dwelling older adults, occurs disproportionately among obese individuals, is associated with characteristics of poor health and independently associated with mortality. These results indicate that RIWL needs to be considered an adverse health indicator even among obese individuals and despite the absence of several clinical indicators of disease.

Micronutrient status in Jordan: 2002 and 2010.

BACKGROUND/OBJECTIVES: Two national surveys were conducted in Jordan in 2002 and 2010 to investigate the micronutrient status in women and children. To determine the prevalence of anemia, iron and folate deficiency among women and children in 2010 and compare with the prevalence of anemia and iron deficiency in 2002. SUBJECTS/METHODS: A nationally representative survey was conducted in 2002 (1023 women, 15-49 years of age; 1059 children, 12-59 months of age) and a second survey in 2010 (2035 women; 940 children). Venous blood samples were used to measure hemoglobin, ferritin and red blood cell folate (the latter on a subsample of 393 women). RESULTS: Among women in 2010, the prevalence of folate deficiency and insufficiency was 13.6% and 82.9%, respectively. Geometric mean serum ferritin was higher in 2010 compared with 2002 (21.3 ng/ml vs 18.3, P=0.01); there was no significant change in the prevalence of iron deficiency (35.1% vs 38.7%, P=0.17), iron deficiency anemia (19.1% vs 20.0%, P=0.61) or anemia (29.2% vs 29.3%, P=0.96). Among children, a significantly lower prevalence was observed in 2010 compared with 2002 for iron deficiency (13.7% vs 26.2% P<0.001) and iron deficiency anemia (4.8% vs 10.1%, P<0.001); a nonsignificant lower prevalence was observed for anemia (16.6% vs 20.2%, P=0.09). CONCLUSIONS: In 2010, approximately one of seven women was folate deficient and six out of seven were folate insufficient for the prevention of neural tube defects. Between 2002 and 2010, significant improvement was observed in the prevalence of iron deficiency in children, but not in women.

Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6-24 months of age in the Kyrgyz Republic.

BACKGROUND/OBJECTIVES: To combat iron and other micronutrient deficiencies, the Ministry of Health of the Kyrgyz Republic launched a regional Infant and Young Child Nutrition (IYCN) program in 2009, which included promotion of home fortification with micronutrient powder (MNP) containing iron (12.5 mg elemental iron), vitamin A (300 µg) and other micronutrients. Every 2 months children aged 6-24 months were provided 30 sachets to be taken on a flexible schedule. The objective was to assess biochemical indicators of iron and vitamin A status among children aged 6-24 months at the baseline and follow-up surveys. SUBJECTS/METHODS: Cross-sectional representative cluster surveys were conducted in 2008 (n=571 children) and 2010 (n=541). Data collected included measurement of hemoglobin, serum ferritin, soluble transferrin receptor (sTfR), retinol-binding protein, C-reactive protein (CRP) and α1-glycoprotein acid (AGP). RESULTS: Among all children, declines were observed in the prevalence of: anemia, 50.6% versus 43.8% (P=0.05); total iron deficiency (either low ferritin or high sTfR), 77.3% versus 63.7% (P<0.01); and iron deficiency anemia, 45.5% versus 33.4% (P<0.01). Among children without inflammation as measured by CRP and AGP, similar declines were observed, but only declines in total iron deficiency and iron deficiency anemia reached statistical significance. Among all children and those without inflammation, the prevalence of vitamin A deficiency remained the same. CONCLUSIONS: One year after the introduction of home fortification with MNP, within a larger IYCN program, the prevalence of anemia, iron deficiency and iron deficiency anemia declined, but vitamin A deficiency remained unchanged.

Vitamin D status and determinants of deficiency among non-pregnant Jordanian women of reproductive age.

BACKGROUND/OBJECTIVES: Vitamin D deficiency, a risk factor for osteomalacia and osteoporosis, is a re-emerging health problem globally. While sunlight is an important vitamin D source, previous investigations among women whose culture encourages skin covering have been small, not nationally representative, or both. We investigated serum 25-hydroxyvitamin D (25(OH)D(3)) status and factors associated with deficiency in a nationally representative survey of 2013 Jordanian women of reproductive age in Spring 2010. SUBJECTS/METHODS: We measured 25(OH)D(3) concentrations by liquid chromatography-tandem mass spectrometry and calculated prevalence ratios for deficiency associated with skin covering and other factors. RESULTS: Results showed 60.3% (95% CI: 57.1-63.4%) deficiency (<12 ng/ml) and 95.7% (95% CI: 94.4-96.8%) insufficiency (<20 ng/ml) among women. Prevalence of deficiency was 1.60 times higher for women who covered with a scarf/hijab (95% CI: 1.06-2.40, P = 0.024) and 1.87 times higher for women who wore full cover, or a niqab (95% CI: 1.20-2.93, P = 0.006), compared with the women who did not wear a scarf/hijab or niqab. Compared with rural women completing at least secondary education, prevalence of deficiency was 1.30 times higher for urban women of the same education level (95% CI: 1.08-1.57, P = 0.006), 1.18 times higher for urban women completing less than secondary education (95% CI: 0.98-1.43, P = 0.09), and 0.66 times lower for rural women completing less than secondary education (95% CI: 0.52-0.84, P = 0.001). CONCLUSION: Vitamin D deficiency and insufficiency pose significant public health problems in Jordanian women. Prevalence of deficiency is significantly higher among urban women and among women who cover with a scarf/hijab or niqab.