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.

Reasons for Nonparticipation in the Special Supplemental Nutrition Program for Women, Infants, and Children.

This cross-sectional study evaluates reasons reported for not participating in or withdrawing participation from the Special Supplemental Nutrition Program for Women, Infants, and Children from 2019 to March 2020.

Dairy, Meat, Seafood, and Plant Sources of Saturated Fat: United States, Ages Two Years and Over, 2017-2020.

BACKGROUND: Research suggests that the effects of saturated fat (SF) on health differ depending on its food source. Dairy SF has been associated with lower cardiovascular disease (CVD) risk, whereas meat SF is linked to a higher CVD risk. OBJECTIVES: To estimate the contribution to the total intake of SF of 1) 5 food groups - dairy, meats, seafood, plants, and "other," and 2) the top 10 specific food category sources in the United States population overall and by sociodemographic subgroup. METHODS: The analysis included data from 11,798 participants in the 2017-March 2020 National Health and Nutrition Examination Survey aged 2+ y. Grams of SF from the food sources expressed as a percentage of the total grams of SF consumed, were estimated using the population ratio method. RESULTS: Mean daily intake of SF was 28.1 g [95% confidence interval (CI): 27.6-28.6 g], comprising 11.9% (95% CI: 11.7-12.1%) of total energy intake. Dairy contributed 28.4% of SF, followed by meats (22.1%), plant sources (7.5%), fish and seafood (1.2%), and the remaining foods (41.6%). Youth had higher SF intake from dairy than adults (P < 0.001), whereas non-Hispanic Whites had higher intake than non-Hispanic Blacks (P < 0.001) and Hispanics (P = 0.016). Adults had higher SF intake from meats than youth (P = 0.002), males more than females (P < 0.001), and non-Hispanic Blacks more than non-Hispanic Asians (P = 0.016) and Hispanics (P < 0.001). The top 10 specific sources of SF were unprocessed red meats, sweet bakery products, cured meats, milk, cheese, pizza, unprocessed poultry, Mexican mixed dishes, eggs, and combined fruits and vegetables. CONCLUSIONS: Although dairy contributed ∼30% of SF compared to ∼20% for total meat, the top specific food category source of SF was unprocessed red meats, which ranked in the top 2 food category sources of SF for most subgroups. These findings may be useful for further research to examine the relationship between the different sources of SF and health outcomes.

Trends in Food Consumption Among Children Aged 1-4 Years by Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children, United States, 2005-2018.

BACKGROUND: In 2009, the US Department of Agriculture Food and Nutrition Service's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages were revised to include more whole fruits, vegetables, whole grains, and lower-fat milk. OBJECTIVE: The aim of this study was to describe trends over time in the consumption of fruits (total and whole), vegetables, whole grains, milk (whole, reduced fat, low-fat or nonfat (LFNF), and flavored), and added sugars, including breakfast cereals, by WIC participation status (current WIC recipient, WIC income-eligible nonrecipient, and WIC income-ineligible nonrecipient). METHODS: Dietary intakes on a given day for 1- to 4-y-old children (n = 5568) from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed to examine trends in the percentage of individuals consuming and amounts consumed over time using linear regression adjusted for age, sex, and race and Hispanic origin. RESULTS: From 2005 through 2018, the percentage of WIC recipients or WIC income-eligible nonrecipients consuming fruits and vegetables on a given day did not change, but the percentage of fruit consumed as whole fruit increased significantly among WIC recipients (36.4%-62.1%), but not among income-eligible nonrecipients. Among the WIC recipients, the percentage of consumption (5.5%-29.3%), the amount of LFNF milk servings consumed (0.1-0.4 cups), and the percentage of the total milk consumed as LFNF milk (4.8%-27%) significantly increased from 2005 to 2018. Conversely, the percentage of energy (12.3%-10.8%) and servings (11.4-10.6 teaspoons) from added sugars declined significantly. Among WIC-eligible nonrecipients, the servings of whole grains increased significantly, whereas servings and percentage of energy from added sugars declined significantly. CONCLUSIONS: From 2005 through 2018, changes in dietary patterns for WIC recipients did not always mirror those of US children of the same age. The percentage of fruit consumed as whole fruit, and the percentage and quantity of milk consumed as LFNF milk increased significantly among WIC recipients, but not among income-eligible nonrecipients. J Nutr 20XX;xx:xx-xx.

Awareness of the MyPlate Plan: United States, 2017-March 2020.

Objective-The United States Department of Agriculture's MyPlate is based on the Dietary Guidelines for Americans and serves as the primary educational tool to communicate federal dietary guidance. This report presents the percentage of adults who have heard of MyPlate and who have tried MyPlate along with their associations with self-rated diet quality.

Mean Body Weight, Height, Waist Circumference, and Body Mass Index Among Children and Adolescents: United States, 1999-2018.

Objective-This report presents trends in mean weight, recumbent length, height, waist circumference, and body mass index (BMI) among children and adolescents in the United States from 1999 through 2018.

Anthropometric Reference Data for Children and Adults: United States, 2015-2018.

Based on nationally representative anthropometric data, the National Center for Health Statistics (NCHS) has published reference tables on the distribution of various body measurements for the U.S. population (1-5). National Health and Nutrition Examination Survey (NHANES) data are the primary source of body measurement information for the U.S. population. These measurements reflect the mean weight, height, length, and various circumferences of U.S. children and adults. Anthropometry is a measure of nutritional or general health status, dietary adequacy, and growth. This report presents anthropometric reference data from the years 2015-2018 for U.S. children and adults.

Fast Food Intake Among Children and Adolescents in the United States, 2015-2018.

Fast food has been associated with higher caloric intake and poorer diet quality in children and adolescents (1). In 2011-2012, children and adolescents aged 2-19 years consumed on average 12.4% of their daily calories from fast food on a given day (2). This report presents 2015-2018 estimates of the percentage of calories consumed from fast food on a given day among U.S. children and adolescents by demographic characteristics and trends since 2003.

Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018.

Obesity is associated with serious health risks (1). Severe obesity further increases the risk of obesity-related complications, such as coronary heart disease and end-stage renal disease (2,3). From 1999-2000 through 2015-2016, a significantly increasing trend in obesity was observed (4). This report provides the most recent national data for 2017-2018 on obesity and severe obesity prevalence among adults by sex, age, and race and Hispanic origin. Trends from 1999-2000 through 2017-2018 for adults aged 20 and over are also presented.

Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017-2018.

Hypertension is a major risk factor for cardiovascular disease. Lowering blood pressure has been shown to decrease the incidences of stroke, heart attack, and heart failure (1,2). This report provides 2017-2018 U.S. hypertension prevalence estimates using the 2017 American College of Cardiology and American Heart Association definition of hypertension (3) and new guidelines, which redefine hypertension by lowering the previous threshold levels of 140/90 mmHg to 130/80 mmHg (4). This change categorizes a greater percentage of people as having hypertension.

Added Sugars Intake among US Infants and Toddlers.

BACKGROUND: Limited information is available on added sugars consumption in US infants and toddlers. OBJECTIVES: To present national estimates of added sugars intake among US infants and toddlers by sociodemographic characteristics, to identify top sources of added sugars, and to examine trends in added sugars intake. DESIGN: Cross-sectional analysis of 1 day of 24-hour dietary recall data. PARTICIPANTS/SETTING: A nationally representative sample of US infants aged 0 to 11 months and toddlers aged 12 to 23 months (n=1,211) during the period from 2011 through 2016 from the National Health and Nutrition Examination Survey. Trends were assessed from 2005-2006 through 2015-2016 (n=2,795). MAIN OUTCOME MEASURES: Among infants and toddlers, the proportion consuming any added sugars, the average amount of added sugars consumed, percent of total energy from added sugars, and top sources of added sugars intake. STATISTICAL ANALYSIS: Paired t tests were used to compare differences by age, sex, race/Hispanic origin, family income level, and head of household education level. Trends were tested using orthogonal polynomials. Significance was set at P<0.05. RESULTS: During 2011 to 2016, 84.4% of infants and toddlers consumed added sugars on a given day. A greater proportion of toddlers (98.3%) consumed added sugars than infants (60.6%). The mean amount of added sugars toddlers consumed was also more compared with infants (5.8 vs 0.9 tsp). Non-Hispanic black toddlers (8.2 tsp) consumed more added sugars than non-Hispanic Asian (3.7 tsp), non-Hispanic white (5.3 tsp), and Hispanic (5.9 tsp) toddlers. A similar pattern was observed for percent energy from added sugars. For infants, top sources of added sugars were yogurt, baby food snacks/sweets, and sweet bakery products; top sources among toddlers were fruit drinks, sugars/sweets, and sweet bakery products. The mean amount of added sugars decreased from 2005-2006 through 2015-2016 for both age groups; however, percent energy from added sugars only decreased among infants. CONCLUSION: Added sugars intake was observed among infants/toddlers and varied by age and race and Hispanic origin. Added sugars intake, as a percent of energy, decreased only among infants from 2005 to 2016.

The association of nativity/length of residence and cardiovascular disease risk factors in the United States.

Differences by nativity status for cardiovascular disease (CVD) risk factors have been previously reported. Recent research has focused on understanding how other acculturation factors, such as length of residence, affect health behaviors and outcomes. This study examines the association between CVD risk factors and nativity/length of US residence. Using cross-sectional data from 15,965 adults in the 2011-2016 National Health and Nutrition Examination Surveys (analyzed in 2018), prevalence ratios and predicted marginals from logistic regression models are used to estimate associations of CVD risk factors (i.e., hypertension, hypercholesterolemia, diabetes, overweight/obesity and smoking) with nativity/length of residence (<15 years, ≥15 years) in the US. In sex-, age-, education- and race and Hispanic origin- adjusted analyses, a higher percentage of US (50 states and District of Columbia) born adults (86.4%) had ≥1 CVD risk factor compared to non-US born residents in the US <15 years (80.1%) but not ≥15 years (85.1%). Compared to US born counterparts, regardless of length of residence, hypertension overall and smoking among non-Hispanic white and Hispanic adults were lower among non-US born residents. Overweight/obesity overall and diabetes among Hispanic adults were lower among non-US born residents in the US <15 years. In contrast, non-US born non-Hispanic Asian residents in the US <15 years had higher prevalence of diabetes. Non-US born adults were less likely to have most CVD risk factors compared to US born adults regardless of length of residence, although, for smoking and diabetes this pattern differed by race and Hispanic origin.

Comparisons of Self-Reported and Measured Height and Weight, BMI, and Obesity Prevalence from National Surveys: 1999-2016.

OBJECTIVE: The aim of this study was to compare national estimates of self-reported and measured height and weight, BMI, and obesity prevalence among adults from US surveys. METHODS: Self-reported height and weight data came from the National Health and Nutrition Examination Survey (NHANES), the National Health Interview Survey, and the Behavioral Risk Factor Surveillance System for the years 1999 to 2016. Measured height and weight data were available from NHANES. BMI was calculated from height and weight; obesity was defined as BMI ≥ 30. RESULTS: In all three surveys, mean self-reported height was higher than mean measured height in NHANES for both men and women. Mean BMI from self-reported data was lower than mean BMI from measured data across all surveys. For women, mean self-reported weight, BMI, and obesity prevalence in the National Health Interview Survey and Behavioral Risk Factor Surveillance System were lower than self-report in NHANES. The distribution of BMI was narrower for self-reported than for measured data, leading to lower estimates of obesity prevalence. CONCLUSIONS: Self-reported height, weight, BMI, and obesity prevalence were not identical across the three surveys, particularly for women. Patterns of misreporting of height and weight and their effects on BMI and obesity prevalence are complex.

Fast Food Consumption Among Adults in the United States, 2013-2016.

Fast food is a part of the American diet and has been associated with high caloric intake (1), and poor diet quality (2). Time, financial resources, price, and availability influence fast food consumption (3). This report presents data on the percentage of adults who consumed fast food on a given day in the United States during 2013-2016.

Trends in active transportation and associations with cardiovascular disease risk factors among U.S. adults, 2007-2016.

Active transportation (AT), or walking or bicycling for transportation, represents one way individuals can achieve recommended physical activity (PA) levels. This study describes AT prevalence and temporal trends, and examines associations between AT levels and measured CVD risk factors (hypertension, hypercholesterolemia, low high-density [HDL] cholesterol, diabetes, and obesity) among U.S. adults. National Health and Nutrition Examination Survey (NHANES) 2007-2016 data (analyzed in 2017) were used to conduct overall trend analyses of reported AT in a typical week [none (0-9 min/week); low (10-149 min/week); or high (≥150 min/week)]. Logistic regression was used to examine associations between AT level and each CVD risk factor from NHANES 2011-2016 (n = 13,943). Covariates included age, sex, race/Hispanic origin, education, income, smoking, survey cycle, non-transportation PA, and urbanization level. U.S. adults who engaged in high AT levels increased from 13.1% in 2007-2008 to 17.9% in 2011-2012, and then decreased to 10.6% in 2015-2016 (p for quadratic trend = 0.004). Over the same period, the quadratic trend for low AT was not significant. During 2011-2016, 14.3% of adults engaged in high AT, 11.4% in low AT, and 74.4% in no AT. High AT levels were associated with decreased odds of each CVD risk factor assessed, compared to no AT. Low AT (versus no AT) was associated with decreased odds of hypertension (aOR = 0.77, 95% CI 0.64, 0.91) and diabetes (aOR = 0.68, 95% CI 0.54, 0.85). AT prevalence among adults has fluctuated from 2007 to 2016. Despite favorable associations between AT and CVD risk factors, most U.S. adults do not engage in any AT.

Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016.

Importance: Differences in childhood obesity by demographics and urbanization have been reported. Objective: To present data on obesity and severe obesity among US youth by demographics and urbanization and to investigate trends by urbanization. Design, Setting, and Participants: Measured weight and height among youth aged 2 to 19 years in the 2001-2016 National Health and Nutrition Examination Surveys, which are serial, cross-sectional, nationally representative surveys of the civilian, noninstitutionalized population. Exposures: Sex, age, race and Hispanic origin, education of household head, and urbanization, as assessed by metropolitan statistical areas (MSAs; large: ≥ 1 million population). Main Outcomes and Measures: Prevalence of obesity (body mass index [BMI] ≥95th percentile of US Centers for Disease Control and Prevention [CDC] growth charts) and severe obesity (BMI ≥120% of 95th percentile) by subgroups in 2013-2016 and trends by urbanization between 2001-2004 and 2013-2016. Results: Complete data on weight, height, and urbanization were available for 6863 children and adolescents (mean age, 11 years; female, 49%). In 2013-2016, the prevalence among youth aged 2 to 19 years was 17.8% (95% CI, 16.1%-19.6%) for obesity and 5.8% (95% CI, 4.8%-6.9%) for severe obesity. Prevalence of obesity in large MSAs (17.1% [95% CI, 14.9%-19.5%]), medium or small MSAs (17.2% [95% CI, 14.5%-20.2%]) and non-MSAs (21.7% [95% CI, 16.1%-28.1%]) were not significantly different from each other (range of pairwise comparisons P = .09-.96). Severe obesity was significantly higher in non-MSAs (9.4% [95% CI, 5.7%-14.4%]) compared with large MSAs (5.1% [95% CI, 4.1%-6.2%]; P = .02). In adjusted analyses, obesity and severe obesity significantly increased with greater age and lower education of household head, and severe obesity increased with lower level of urbanization. Compared with non-Hispanic white youth, obesity and severe obesity prevalence were significantly higher among non-Hispanic black and Hispanic youth. Severe obesity, but not obesity, was significantly lower among non-Hispanic Asian youth than among non-Hispanic white youth. There were no significant linear or quadratic trends in obesity or severe obesity prevalence from 2001-2004 to 2013-2016 for any urbanization category (P range = .07-.83). Conclusions and Relevance: In 2013-2016, there were differences in the prevalence of obesity and severe obesity by age, race and Hispanic origin, and household education, and severe obesity was inversely associated with urbanization. Demographics were not related to the urbanization findings.

Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016.

Importance: Differences in obesity by sex, age group, race and Hispanic origin among US adults have been reported, but differences by urbanization level have been less studied. Objectives: To provide estimates of obesity by demographic characteristics and urbanization level and to examine trends in obesity prevalence by urbanization level. Design, Setting, and Participants: Serial cross-sectional analysis of measured height and weight among adults aged 20 years or older in the 2001-2016 National Health and Nutrition Examination Survey, a nationally representative survey of the civilian, noninstitutionalized US population. Exposures: Sex, age group, race and Hispanic origin, education level, smoking status, and urbanization level as assessed by metropolitan statistical areas (MSAs; large: ≥1 million population). Main Outcomes and Measures: Prevalence of obesity (body mass index [BMI] ≥30) and severe obesity (BMI ≥40) by subgroups in 2013-2016 and trends by urbanization level between 2001-2004 and 2013-2016. Results: Complete data on weight, height, and urbanization level were available for 10 792 adults (mean age, 48 years; 51% female [weighted]). During 2013-2016, 38.9% (95% CI, 37.0% to 40.7%) of US adults had obesity and 7.6% (95% CI, 6.8% to 8.6%) had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs (42.4% vs 31.8%, respectively; adjusted difference, 9.8 percentage points [95% CI, 5.1 to 14.5 percentage points]); however, the age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs (38.9% vs 31.8%, respectively; adjusted difference, 4.8 percentage points [95% CI, -2.9 to 12.6 percentage points]). The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs (42.5% vs 38.1%, respectively; adjusted difference, 4.3 percentage points [95% CI, 0.2 to 8.5 percentage points]) and among women living in non-MSAs compared with women living in large MSAs (47.2% vs 38.1%, respectively; adjusted difference, 4.7 percentage points [95% CI, 0.2 to 9.3 percentage points]). Similar patterns were seen for severe obesity except that the difference between men living in large MSAs compared with non-MSAs was significant. The age-adjusted prevalence of obesity and severe obesity also varied significantly by age group, race and Hispanic origin, and education level, and these patterns of variation were often different by sex. Between 2001-2004 and 2013-2016, the age-adjusted prevalence of obesity and severe obesity significantly increased among all adults at all urbanization levels. Conclusions and Relevance: In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity and severe obesity in 2013-2016 varied by level of urbanization, with significantly greater prevalence of obesity and severe obesity among adults living in nonmetropolitan statistical areas compared with adults living in large metropolitan statistical areas.