Prevalence of Diabetes by BMI: China Nutrition and Health Surveillance (2015-2017) and U.S. National Health and Nutrition Examination Survey (2015-2018).

Introduction: The risk of diabetes begins at a lower BMI among Asian adults. This study compares the prevalence of diabetes between the U.S. and China by BMI. Methods: Data from the 2015-2017 China Nutrition and Health Surveillance (n=176,223) and the 2015-2018 U.S. National Health and Nutrition Examination Survey (n=4,464) were used. Diagnosed diabetes was self-reported. Undiagnosed diabetes was no report of diagnosed diabetes and fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%. Predicted age-adjusted prevalence estimates by BMI were produced using sex- and country-specific logistic regression models. Results: In China, the age-adjusted prevalence of total diabetes was 7.8% (95% CI=7.4%, 8.3%), lower than the 14.6% (95% CI=13.1%, 16.3%) in the U.S. The prevalence of diagnosed diabetes was also lower in China than in the U.S. There were no statistically significant differences in the prevalence of undiagnosed diabetes between China and the U.S. The distribution of BMI in China was lower than in the U.S., and the predicted prevalence of total diabetes was similar between China and the U.S. when comparing adults with the same BMI. The predicted prevalence of undiagnosed diabetes was higher in China than in the U.S. for both men and women, and this disparity increased with BMI. When comparing adults at the same BMI, there was little difference in the prevalence of total diabetes, but diagnosed diabetes was lower in China than in the U.S., and undiagnosed was higher. Conclusions: Although differences in BMI appear to explain nearly all of the differences in total diabetes prevalence in the 2 countries, not all factors that are associated with diabetes risk have been investigated.

US Population-referenced Percentiles for Wrist-Worn Accelerometer-derived Activity.

PURPOSE: This study aimed to present age- and sex-specific percentiles for daily wrist-worn movement metrics in US youth and adults. This metric represents a summary of all recorded movement, regardless of the purpose, context, or intensity. METHODS: Wrist-worn accelerometer data from the combined 2011-2014 National Health and Nutrition Examination Survey cycles and the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey were used for this analysis. Monitor-Independent Movement Summary units (MIMS-units) from raw triaxial accelerometer data were used. We removed the partial first and last assessment days and days with ≥5% nonwear time. Participants with ≥1 valid day were included. Mean MIMS-units were calculated across all valid days. Percentile tables and smoothed curves of daily MIMS-units were calculated for each age and sex using the Generalized Additive Models for Location Shape and Scale. RESULTS: The analytical sample included 14,705 participants age ≥3 yr. The MIMS-unit activity among youth was similar for both sexes, whereas adult females generally had higher MIMS-unit activity than did males. Median daily MIMS-units peaked at age 6 yr for both sexes (males, 20,613; females, 20,706). Lowest activity was observed for males and females 80+ yr of age: 8799 and 9503, respectively. CONCLUSIONS: Population referenced MIMS-unit percentiles for US youth and adults are a novel means of characterizing total activity volume. By using MIMS-units, we provide a standardized reference that can be applied across various wrist-worn accelerometer devices. Further work is needed to link these metrics to activity intensity categories and health outcomes.

Prevalence of Total, Diagnosed, and Undiagnosed Diabetes Among Adults: United States, 2013-2016.

Diabetes is a major cause of morbidity and mortality in the United States (1-3). Diabetes can be present but undiagnosed, meaning that a person can have diabetes but not report having ever been told by a doctor or health professional that they have the condition. Type 2 diabetes can progress over an extended time period with gradual, often unnoticed, changes occurring before diagnosis. If left unmanaged, diabetes may contribute to serious health outcomes including neuropathy, nephropathy, retinopathy, coronary artery disease, stroke, and peripheral vascular disease (4). This report presents the prevalence of total, diagnosed, and undiagnosed diabetes in U.S. adults in 2013-2016.

Depressive states among adults with diabetes: Findings from the National Health and Nutrition Examination Survey, 2007-2012.

AIMS: To determine (1) the prevalence of SubD states among adults with diabetes, and (2) whether evidence exists of an independent association between diabetes status and SubD, controlling for selected confounders. METHODS: Data from the 2007-2012 National Health and Nutrition Examination Surveys were combined to estimates of depressive states by diabetes status among the noninstitutionalized U.S. adult population, and to assess the association of diabetes status and depressive states using a polytomous logistic regression model. RESULTS: An estimated 17%, or 3.7 million, of U.S. adults with diabetes (diagnosed and undiagnosed) met criteria for either mD or ssD. The majority of SubD cases with diabetes were found to be ssD (10.1%) compared with mD (6.9%). After controlling for the effects of age, sex, race and ethnicity, education, body mass index, and poverty as covariates, an independent association persists between diagnosed diabetes and each SubD grouping (ssD: OR=1.82, CIs 1.33, 2.47; mD: OR=1.95, CIs 1.39, 2.74) compared with respondents having no diabetes. No association was found between depression and undiagnosed diabetes or prediabetes compared with those having no diabetes. CONCLUSION: Milder forms of depression such as ssD and mD are more extant than major depressive episodes among adults with diabetes. The odds that an adult with diagnosed diabetes meets the criteria for ssD or mD are higher by 80% and 95%, respectively, after controlling for age, sex, race and ethnicity, education, body mass index, and poverty factors when compared against adults with no diabetes.

Trends in Prevalence of Chronic Kidney Disease in the United States.

Background: Trends in the prevalence of chronic kidney disease (CKD) are important for health care policy and planning. Objective: To update trends in CKD prevalence. Design: Repeated cross-sectional study. Setting: NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012. Participants: Adults aged 20 years or older. Measurements: Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m2, estimated with the Chronic Kidney Disease Epidemiology Collaboration equation from calibrated serum creatinine measurements. An expanded definition of CKD also included persons with an eGFR of at least 60 mL/min/1.73 m2 and a 1-time urine albumin-creatinine ratio of at least 30 mg/g. Results: The unadjusted prevalence of stage 3 and 4 CKD increased from the late 1990s to the early 2000s. Since 2003 to 2004, however, the overall prevalence has largely stabilized (for example, 6.9% prevalence in 2003 to 2004 and in 2011 to 2012). There was little difference in adjusted prevalence of stage 3 and 4 CKD overall in 2003 to 2004 versus 2011 to 2012 after age, sex, race/ethnicity, and diabetes mellitus status were controlled for (P = 0.26). Lack of increase in CKD prevalence since the early 2000s was observed in most subgroups and with an expanded definition of CKD that included persons with higher eGFRs and albuminuria. Limitation: Serum creatinine and albuminuria were measured only once in each person. Conclusion: In a reversal of prior trends, there has been no appreciable increase in the prevalence of stage 3 and 4 CKD in the U.S. population overall during the most recent decade. Primary Funding Source: American Society of Nephrology Foundation for Kidney Research Student Scholar Grant Program, Centers for Disease Control and Prevention, and National Institutes of Health.

Diabetes and fracture risk in older U.S. adults.

OBJECTIVE: We examined the diabetes-fracture relationship by race/ethnicity, including the link between pre-diabetes and fracture. RESEARCH DESIGN AND METHODS: We used Medicare- and mortality-linked data for respondents aged 65years and older from the third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2004 for three race/ethnic groups: non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Mexican Americans (MA). Diabetes was defined as diagnosed diabetes (self-reported) and diabetes status: diagnosed and undiagnosed diabetes (positive diagnosis or hemoglobin A1c (A1C)≥6.5%); pre-diabetes (no diagnosis and A1C between 5.7% and 6.4%); and no diabetes (no diagnosis and A1C<5.7%). Non-skull fractures (n=750) were defined using published algorithms. Hazards ratios (HRs) were calculated using Cox proportional hazards models. RESULTS: The diabetes-fracture relationship differed significantly by race/ethnicity (pinteraction<0.05). Compared to those without diagnosed diabetes, the HRs for those with diagnosed diabetes were 2.37 (95% CI 1.49-3.75), 1.87 (95% CI 1.02-3.40), and 1.22 (95% CI 0.93-1.61) for MA, NHB, and NHW, respectively, after adjusting for significant confounders. HRs for diagnosed and undiagnosed diabetes were similar to those for diagnosed diabetes alone. Pre-diabetes was not significantly related to fracture risk, however. Compared to those without diabetes, adjusted HRs for those with pre-diabetes were 1.42 (95% CI 0.72-2.81), and 1.20 (95% CI 0.96-1.51) for MA and NHW, respectively. There were insufficient fracture cases to examine detailed diabetes status in NHB. CONCLUSIONS: The diabetes-fracture relationship was stronger in MA and NHB. Pre-diabetes was not significantly associated with higher fracture risk, however.

Preventive Aspirin and Other Antiplatelet Medication Use Among U.S. Adults Aged ≥ 40 Years: Data from the National Health and Nutrition Examination Survey, 2011-2012.

OBJECTIVE: We estimated the prevalence of preventive aspirin and/or other antiplatelet medication use and the dosage of aspirin use in the U.S. adult population. METHODS: We conducted cross-sectional analyses of a representative sample (n=3,599) of U.S. adults aged ≥ 40 years from the National Health and Nutrition Examination Survey, 2011-2012. RESULTS: In 2011-2012, one-third of U.S. adults aged ≥ 40 years reported taking preventive aspirin and/or other antiplatelet medications, 97% of whom indicated preventive aspirin use. Preventive aspirin use increased with age (from 11% of those aged 40-49 years to 54% of those ≥ 80 years of age, p<0.001). Non-Hispanic white (35%) and black (30%) adults were more likely to take preventive aspirin than non-Hispanic Asian (20%, p<0.001) and Hispanic (22%, p=0.013) adults. Adults with, compared with those without health insurance, and adults with ≥ 2 doctor visits in the past year, diagnosed diabetes, hypertension, or high cholesterol were twice as likely to take preventive aspirin. Among those with cardiovascular disease, 76% reported taking preventive aspirin and/or other antiplatelet medications, of whom 91% were taking preventive aspirin. Among adults without cardiovascular disease, 28% reported taking preventive aspirin. Adherence rates to medically recommended aspirin use were 82% overall, 91% for secondary prevention, and 79% for primary prevention. Among current preventive aspirin users, 70% were taking 81 milligrams (mg) of aspirin daily and 13% were taking 325 mg of aspirin daily. CONCLUSION: The vast majority of antiplatelet therapy is preventive aspirin use. A health-care provider's recommendation to take preventive aspirin is an important determinant of current preventive aspirin use.

Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994.

Previous estimates of the prevalence of nonalcoholic fatty liver disease (NAFLD) in the US population relied on measures of liver enzymes, potentially underestimating the burden of this disease. We used ultrasonography data from 12,454 adults who participated in the Third National Health and Nutrition Examination Survey, conducted in the United States from 1988 to 1994. We defined NAFLD as the presence of hepatic steatosis on ultrasonography in the absence of elevated alcohol consumption. In the US population, the rates of prevalence of hepatic steatosis and NAFLD were 21.4% and 19.0%, respectively, corresponding to estimates of 32.5 (95% confidence interval: 29.9, 35.0) million adults with hepatic steatosis and 28.8 (95% confidence interval: 26.6, 31.2) million adults with NAFLD nationwide. After adjustment for age, income, education, body mass index (weight (kg)/height (m)²), and diabetes status, NAFLD was more common in Mexican Americans (24.1%) compared with non-Hispanic whites (17.8%) and non-Hispanic blacks (13.5%) (P = 0.001) and in men (20.2%) compared with women (15.8%) (P < 0.001). Hepatic steatosis and NAFLD were also independently associated with diabetes, with insulin resistance among people without diabetes, with dyslipidemia, and with obesity. Our results extend previous national estimates of the prevalence of NAFLD in the US population and highlight the burden of this disease. Men, Mexican Americans, and people with diabetes and obesity are the most affected groups.

Association between variants in or near PNPLA3, GCKR, and PPP1R3B with ultrasound-defined steatosis based on data from the third National Health and Nutrition Examination Survey.

BACKGROUND & AIMS: A genome-wide association study associated 5 genetic variants with hepatic steatosis (identified by computerized tomography) in individuals of European ancestry. We investigated whether these variants were associated with measures of hepatic steatosis (HS) in non-Hispanic white (NHW), non-Hispanic black, and Mexican American (MA) participants in the US population-based National Health and Nutrition Examination Survey III, phase 2. METHODS: We analyzed data from 4804 adults (1825 NHW, 1442 non-Hispanic black, and 1537 MA; 51.7% women; mean age at examination, 42.5 y); the weighted prevalence of HS was 37.3%. We investigated whether ultrasound-measured HS, with and without increased levels of alanine aminotransferase (ALT), or level of ALT alone, was associated with rs738409 (patatin-like phospholipase domain-containing protein 3 [PNPLA3]), rs2228603 (neurocan [NCAN]), rs12137855 (lysophospholipase-like 1), rs780094 (glucokinase regulatory protein [GCKR]), and rs4240624 (protein phosphatase 1, regulatory subunit 3b [PPP1R3B]) using regression modeling in an additive genetic model, controlling for age, age-squared, sex, and alcohol consumption. RESULTS: The G allele of rs738409 (PNPLA3) and the T allele of rs780094 (GCKR) were associated with HS with a high level of ALT (odds ratio [OR], 1.36; P = .01; and OR, 1.30; P = .03, respectively). The A allele of rs4240624 (PPP1R3B) and the T allele of rs2228603 (NCAN) were associated with HS (OR, 1.28; P = .03; and OR, 1.40; P = .04, respectively). Variants of PNPLA3 and NCAN were associated with ALT level among all 3 ancestries. Some single-nucleotide polymorphisms were associated with particular races or ethnicities: variants in PNPLA3, NCAN, GCKR, and PPP1R3B were associated with NHW and variants in PNPLA3 were associated with MA. No variants were associated with NHB. CONCLUSIONS: We used data from the National Health and Nutrition Examination Survey III to validate the association between rs738409 (PNPLA3), rs780094 (GCKR), and rs4240624 (PPP1R3B) with HS, with or without increased levels of ALT, among 3 different ancestries. Some, but not all, associations between variants in NCAN, lysophospholipase-like 1, GCKR, and PPP1R3B with HS (with and without increased ALT level) were significant within subpopulations.

Albuminuria prevalence in first morning void compared with previous random urine from adults in the National Health and Nutrition Examination Survey, 2009-2010.

BACKGROUND: Albuminuria, defined as urine albumin/creatinine ratio (ACR) ≥30 mg/g, is a diagnostic component of chronic kidney disease (CKD). National estimates of ACR and CKD prevalence have been based on single random urine samples. Although 2 urine samples or a first morning void are known to produce different estimates of ACR, the impact of differing urine sampling schemes on nationally estimated rates of CKD is unknown. METHODS: In 2009-2010, the National Health and Nutrition Examination Survey (NHANES) participants provided 2 untimed urine samples for sequential ACR measurement: an initial random urine collected in the NHANES mobile examination center and a subsequent first morning void collected at home. Rates of albuminuria were calculated in the overall population and broken down by demographics, diagnosed diabetes and hypertension status, and estimated glomerular filtration rate (eGFR). RESULTS: Overall, 43.5% of adults with increased ACR (≥30 mg/g) in a random urine also had increased ACR in a first morning urine. This percentage was higher among individuals ≥50 years old (48.9%), males (53.3%), participants with diagnosed diabetes (56.3%) and hypertension (51.5%), and eGFR <60 mL/min/1.72m(2) (56.9%). The use of confirmed increased ACR (defined as the presence of ACR ≥30 mg/g in both samples taken within 10 days) to define CKD resulted in a lower overall prevalence (11.6%) than first morning urine (12.7%) or random spot urine only (15.2%). CONCLUSIONS: ACR measured on random urine samples appears to overestimate the prevalence of albuminuria compared to first morning urine collections.

Trends in nutrient intakes and chronic health conditions among Mexican-American adults, a 25-year profile: United States, 1982-2006.

OBJECTIVE: To provide estimates of selected nutrient intakes and chronic health conditions among Mexican-American adults aged 20-74 years in the United States, from 1982 through 2006. METHODS: Data on Mexican-American adults come from the following surveys: the Hispanic Health and Nutrition Examination Survey (HHANES, 1982-1984 (n = 3,935)); the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994 (n = 4,641)); and NHANES 1999-2006 (n = 4,084). Prevalence estimates were calculated and trend analyses were conducted for each nutrient intake and health condition in the study. Statistical significance of differences between common estimates from each survey period was evaluated using two-sided t-tests (p < 0.05). RESULTS: Between 1982-1984 and 1999-2006, the percent kilocalories from total fat, saturated fat, and protein intake among Mexican-American adults decreased, while carbohydrate and mean total energy intake increased. During this same time period, the prevalence of obesity and diabetes among Mexican-American adults increased, the prevalence of dental caries decreased, and the prevalence of high blood pressure remained stable. The overall prevalence of high total serum cholesterol among this group did not differ significantly from 1988-1994 to 1999-2006. CONCLUSION: Monitoring trends in diet and health conditions among Mexican-American adults can inform the development of targeted prevention efforts to improve the health of this rapidly increasing population.

Racial and ethnic differences in weight management behavior by weight perception status.

OBJECTIVE: To examine racial/ethnic differences in the relationship between weight perception and weight management behaviors among overweight and obese adults. PARTICIPANTS: The study examined a nationally representative sample of 11,319 non-Hispanic White, non-Hispanic Black and Mexican American overweight and obese adults aged > or = 20 years from the 1999-2006 National Health and Nutrition Examination Survey. DESIGN: Body mass index (BMI, defined as weight in kilograms divided by height in meters squared) was used to categorize overweight (25 < or = BMI < 30) and obesity (BMI > or = 30). Measured height and weight were used to calculate BMI. Subjects reported self-perception of weight status (correct perception and misperception) and weight management behaviors over the previous 12 months (trying to lose weight, trying not to gain weight, and having a desired weight goal). Weight perception stratified logistic regression was used to model odds of weight management behavior by race/ethnicity. RESULTS: Among overweight and obese non-Hispanic White, non-Hispanic Black, and Mexican American adults, correct weight perception was positively associated with weight management behavior. In multiple logistic regression models, overweight non-Hispanic Blacks with a weight misperception were less likely to have tried to lose weight (adjusted odds ratio [aOR] = .7; 95% confidence interval [Cl] = .5,1.0) or to have tried not to gain weight (aOR = .7; 95% CI = .5,1.0) compared to overweight non-Hispanic Whites with a weight misperception. Among the obese with a misperception, non-Hispanic Blacks were less likely to desire to weigh less compared to non-Hispanic Whites (aOR = .5; 95% CI = .3,.9). CONCLUSIONS: Weight perception was associated with weight management behaviors, and this relationship varied by race/ethnicity. Weight perception may need to be addressed among overweight and obese individuals to increase appropriate weight management behaviors, particularly among minority communities.

Hypertension, high serum total cholesterol, and diabetes: racial and ethnic prevalence differences in U.S. adults, 1999-2006.

KEY FINDINGS: Forty-five percent of adults had at least one of three diagnosed or undiagnosed chronic conditions­hypertension, hypercholesterolemia, or diabetes; one in eight adults (13%) had two of these conditions; and 3% of adults had all three chronic conditions. Nearly one in seven U.S. adults (15%) had one or more of these conditions undiagnosed. Non-Hispanic black persons were more likely than non-Hispanic white and Mexican-American persons to have at least one of the three conditions (diagnosed or undiagnosed). Non-Hispanic black and non-Hispanic white persons were more likely than Mexican-American persons to have both diagnosed or undiagnosed hypertension and hyper-cholesterolemia. Non-Hispanic black and Mexican-American persons were more likely than non-Hispanic white persons to have both diagnosed or undiagnosed hypertension and diabetes.

Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes.

BACKGROUND AND OBJECTIVES: Prevalence of chronic kidney disease (CKD) in people with diagnosed diabetes is known to be high, but little is known about the prevalence of CKD in those with undiagnosed diabetes or prediabetes. We aimed to estimate and compare the community prevalence of CKD among people with diagnosed diabetes, undiagnosed diabetes, prediabetes, or no diabetes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The 1999 through 2006 National Health and Nutrition Examination Survey is a representative survey of the civilian, noninstitutionalized US population. Participants who were aged > or =20 years; responded to the diabetes questionnaire; and had fasting plasma glucose (FPG), serum creatinine, and urinary albumin-creatinine ratio measurements were included (N = 8188). Diabetes status was defined as follows: Diagnosed diabetes, self-reported provider diagnosis (n = 826); undiagnosed diabetes, FPG > or =126 mg/dl without self-reported diagnosis (n = 299); prediabetes, FPG > or =100 and <126 mg/dl (n = 2272); and no diabetes, FPG <100 mg/dl (n = 4791). Prevalence of CKD was defined by estimated GFR 15 to 59 ml/min per 1.73 m(2) or albumin-creatinine ratio > or =30 mg/g; adjustment was performed with multivariable logistic regression. RESULTS: Fully 39.6% of people with diagnosed and 41.7% with undiagnosed diabetes had CKD; 17.7% with prediabetes and 10.6% without diabetes had CKD. Age-, gender-, and race/ethnicity-adjusted prevalence of CKD was 32.9, 24.2, 17.1, and 11.8%, for diagnosed, undiagnosed, pre-, and no diabetes, respectively. Among those with CKD, 39.1% had undiagnosed or prediabetes. CONCLUSIONS: CKD prevalence is high among people with undiagnosed diabetes and prediabetes. These individuals might benefit from interventions aimed at preventing development and/or progression of both CKD and diabetes.

Control of risk factors among people with diagnosed diabetes, by lower extremity disease status.

INTRODUCTION: We examined the control of modifiable risk factors among a national sample of diabetic people with and without lower extremity disease (LED). METHODS: The sample from the 1999-2004 National Health and Nutrition Examination Survey consisted of 948 adults aged 40 years or older with diagnosed diabetes and who had been assessed for LED. LED was defined as peripheral arterial disease (ankle-brachial index <0.9), peripheral neuropathy (> or = 1 insensate area), or presence of foot ulcer. Good control of modifiable risk factors, based on American Diabetes Association recommendations, included being a nonsmoker and having the following measurements: hemoglobin A1c (HbA1c) less than 7%, systolic blood pressure less than or equal to 130 mm Hg, diastolic blood pressure less than or equal to 80 mm Hg, high-density lipoprotein (HDL) cholesterol greater than 50 mg/dL, and body mass index (BMI) between 18.5 kg/m(2) and 24.9 kg/m(2). RESULTS: Diabetic people with LED were less likely than were people without LED to have recommended levels of HbA1c (39.3% vs 53.5%) and HDL cholesterol (29.7% vs 41.1%), but there were no differences in systolic or diastolic blood pressure, BMI classification, or smoking status between people with and without LED. Control of some risk factors differed among population subgroups. Notably, among diabetic people with LED, non-Hispanic blacks were more likely to have improper control of HbA1c (adjusted odds ratio [AOR] = 2.0; 95% confidence interval [CI], 1.1-3.9), systolic blood pressure (AOR = 1.9; 95% CI, 1.1-3.2), and diastolic blood pressure (AOR = 2.6; 95% CI, 1.1-5.8), compared with non-Hispanic whites. CONCLUSION: Control of 2 of 6 modifiable risk factors was worse in diabetic adults with LED compared with diabetic adults without LED. Among diabetic people with LED, non-Hispanic blacks had worse control of 3 of 6 risk factors compared with non-Hispanic whites.

Racial/ethnic differences in weight perception.

The objective of this research was to estimate the prevalence of weight misperception among adults using the most recent nationally representative data, according to measured weight category and to assess the relationship between weight misperception and race/ethnicity. Height and weight were measured as part of the 1999-2006 National Health and Nutrition Examination Survey. The study sample consisted of 17,270 adults aged >or=20 years. BMI was categorized as underweight (BMI < 18.5), healthy weight (18.5 or= 30). Subjects reported self-perception of weight status. Among study subjects, 31.7% of healthy weight adults, 38.1% of overweight adults, and 8.1% of obese adults incorrectly perceived their weight category. Among obese men, the odds of weight misperception were higher for non-Hispanic blacks (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 2.0-4.5) compared to non-Hispanic whites and for persons with less than a high school education (OR = 2.1; 95% CI = 1.3-2.1), compared to those with some college education. Among obese women, the odds of weight misperception were higher for non-Hispanic blacks (OR = 3.4; 95% CI = 1.4, 3.1) and Mexican Americans (OR = 1.9; 95% CI = 1.2, 3.2) compared to non-Hispanic whites and for persons with less than high school education compared to those with some college education (OR = 5.5; 95% CI = 3.3-9.3). Weight misperception is highly prevalent in the US population, and more frequent in racial/ethnic minorities, males, and in persons with lower educational levels. Addressing the issue of weight misperception may help address the problem of obesity in the United States by increasing awareness of healthy weight levels, which may subsequently have an impact on weight-related behavior change.

Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006.

OBJECTIVE: We examined the prevalences of diagnosed diabetes, and undiagnosed diabetes and pre-diabetes using fasting and 2-h oral glucose tolerance test values, in the U.S. during 2005-2006. We then compared the prevalences of these conditions with those in 1988-1994. RESEARCH DESIGN AND METHODS: In 2005-2006, the National Health and Nutrition Examination Survey included a probability sample of 7,267 people aged > or =12 years. Participants were classified according to glycemic status by interview for diagnosed diabetes and by fasting and 2-h glucoses measured in subsamples. RESULTS: In 2005-2006, the crude prevalence of total diabetes in people aged > or =20 years was 12.9%, of which approximately 40% was undiagnosed. In people aged > or =20 years, the crude prevalence of impaired fasting glucose was 25.7% and of impaired glucose tolerance was 13.8%, with almost 30% having either. Over 40% of individuals had diabetes or pre-diabetes. Almost one-third of the elderly had diabetes, and three-quarters had diabetes or pre-diabetes. Compared with non-Hispanic whites, age- and sex-standardized prevalence of diagnosed diabetes was approximately twice as high in non-Hispanic blacks (P < 0.0001) and Mexican Americans (P = 0.0001), whereas undiagnosed diabetes was not higher. Crude prevalence of diagnosed diabetes in people aged > or =20 years rose from 5.1% in 1988-1994 to 7.7% in 2005-2006 (P = 0.0001); this was significant after accounting for differences in age and sex, particularly in non-Hispanic blacks. Prevalences of undiagnosed diabetes and pre-diabetes were generally stable, although the proportion of total diabetes that was undiagnosed decreased in Mexican Americans. CONCLUSIONS: Over 40% of people aged > or =20 years have hyperglycemic conditions, and prevalence is higher in minorities. Diagnosed diabetes has increased over time, but other conditions have been relatively stable.

Relationship of polyunsaturated fatty acid intake to peripheral neuropathy among adults with diabetes in the National Health and Nutrition Examination Survey (NHANES) 1999 2004.

OBJECTIVE: This study investigated the association between dietary intake of polyunsaturated fatty acids (PUFAs) and peripheral neuropathy in the U.S. population. RESEARCH DESIGN AND METHODS: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 for adults >or=40 years of age with diagnosed diabetes, an assessment of peripheral neuropathy, and reliable 24-h dietary recall. The dietary intake of PUFAs was analyzed by peripheral neuropathy status. Multivariate logistic regression models were used to estimate the odds of having peripheral neuropathy in higher quintiles of PUFA intake compared with the lowest quintile. RESULTS: The mean dietary intake of linolenic acid was 1.25 +/- 0.07 g among adults with peripheral neuropathy, significantly lower than the 1.45 +/- 0.05 g intake among those without peripheral neuropathy. After controlling for potential confounding variables, adults whose linolenic acid intake was in the highest quintile had lower odds of peripheral neuropathy than adults in the lowest quintile (adjusted odds ratio 0.40 [95% CI 0.21-0.77]). CONCLUSIONS: Among adults with diagnosed diabetes, dietary intake of linolenic acid is positively associated with lower odds of peripheral neuropathy.

Race and ethnic differences in glycemic control among adults with diagnosed diabetes in the United States.

OBJECTIVE: Control of blood glucose levels reduces vascular complications among people with diabetes, but less than half of the adults with diabetes in the United States are achieving good glycemic control. This study examines 1999-2002 national data on the association between race/ethnicity and glycemic control among adults with previously diagnosed diabetes. DESIGN: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002, a cross-sectional survey of a nationally representative sample of the non-institutionalized civilian US population. Participants were non-pregnant adults, 20 years or older, with a previous diagnosis of diabetes, and who had participated in both the interview and examination in NHANES 1999-2002 (N=843). Glycemic control was determined by levels of glycosylated hemoglobin (A1C). We compared glycemic control by race/ethnicity and potential confounders including measures of socioeconomic status, obesity, healthcare access and diabetes treatment. RESULTS: Overall, 44% of adults with previously diagnosed diabetes had good glycemic control (A1C levels < 7%). Mexican Americans and non-Hispanic Blacks were less likely to achieve good control (35.4% and 36.9%, respectively) compared with non-Hispanic Whites (48.6%). After multivariable adjustment for measures of socioeconomic status, obesity, healthcare access and utilization and diabetes treatment, differences in glycemic control by race/ethnicity remained. CONCLUSION: Glycemic control is low among all racial/ethnic groups, but is lower among non-Hispanic Blacks and Mexican Americans. These results provide guidance for public health workers and health professionals in targeting programs to improve glycemic control among adults with diagnosed diabetes in the United States.