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Physiologic aging leads to attrition of telomeres and replicative senescence. An acceleration of this process has been hypothesized in the progression of chronic liver disease. We sought to examine the association of telomere length (TL) with liver disease and its impact on mortality risk. A cohort of 7,072 adults with leukocyte TL measurements from the National Health and Nutrition Examination Survey 1999‐2002 with mortality follow‐up through 2015 was analyzed. Liver disease was defined by aminotransferase levels and classified into etiology‐based and advanced fibrosis categories. Multivariable‐adjusted linear regression models estimated effect sizes, with 95% confidence intervals (CIs), of the presence of liver disease on TL. Cox regression models evaluated associations between TL and all‐cause mortality risk using adjusted hazard ratios (HRs). The cohort was representative of the US population with mean age 46.1 years and mean TL 5.79 kilobase pairs. No overall association between TL and liver disease was found; however, there was a significant negative association of TL and advanced liver fibrosis in individuals aged 65 and above. The liver disease cohort (HR 1.22, 95% CI 0.99‐1.51) and those with metabolic syndrome (HR 1.26, 95% CI 0.96‐1.67) had increased mortality risk with shorter TL. The relationship between TL and all‐cause mortality was stronger in women (HR 1.51, 95% CI 1.02‐2.23) and in non‐Hispanic Whites (HR 1.37, 95% CI 1.02‐1.84). Conclusion: Shortened leukocyte TL is independently associated with advanced liver disease at older ages, and with a higher risk of all‐cause mortality in those with liver disease. These associations reaffirm the need to better understand the role of telomeres in the progression of liver disease., We examined the association of peripheral telomere length with liver disease and assessed its impact on mortality using data from the National Health and Nutrition Examination Survey (NHANES). We discovered that shortened leukocyte telomere length is independently associated with advanced liver disease at older ages, and also with a higher risk of all‐cause mortality in those with liver disease.

Background It is well established that body composition influences metabolic health, but emerging data are conflicting with the largely purported idea that a large fat‐free mass (FFM) has a protective effect on health. A potential explanation for these discrepancies is the way FFM is represented. The first objective is to determine the association between the metabolic syndrome (MetS) and FFM when the latter was represented in three different ways: 1—absolute FFM; 2—relative to squared height (FFMi); and 3—relative to body weight (FFM%). The second objective is to assess the impact of FFM on the relative risk of having the MetS after taking fat mass, physical activity, and sociodemographic variables into account. Methods A total of 5274 individuals from the National Health and Nutrition Examination Survey database were studied. Age‐specific and sex‐specific quartiles of the three representations of FFM were defined, and the prevalence of MetS was determined in each of them. Quartiles of FFMi (kg/m2) were used to calculate the odds ratios of having the MetS independently of FM, physical activity levels, and sociodemographic variables. Results The prevalence of MetS decreased with increasing quartiles of whole‐body FFM% (Q1: 40%; Q4: 10%) but grew with increasing quartiles of absolute FFM (Q1: 13%; Q4: 40%) and FFMi (Q1: 10%; Q4: 44%). Similar results were observed for appendicular and truncal FFM. The odds ratios of having the MetS, independently of fat mass, physical activity, and sociodemographic variables, were significantly greater in the fourth quartile of FFMi when compared with the first quartiles of each specific subgroup [Q4 vs. Q1: younger men: 4.16 (1.99–8.68); younger women: 5.74 (2.46–13.39); older men: 1.98 (1.22–3.22); older women: 2.88 (1.69–4.90); all P ≤ 0.01]. Conclusions These results support the notion that the representation of FFM significantly influences its association with MetS and that a larger FFM, whether absolute or relative to height, is associated with alterations in cardiometabolic health.

Periodontitis and osteoarthritis are major public health concerns that result in decreased quality of life among middle-aged and older adults. We sought to examine whether the severity of periodontitis is related to osteoarthritis according to the presence of type 2 diabetes mellitus.This study included 3,527 participants age ≥50 years from the Korean National Health and Nutrition Examination Survey. Periodontitis was assessed using the Community Periodontal Index; severe periodontitis was defined as periodontal tissue forming deep periodontal pockets ≥6-mm depth. Osteoarthritis was defined as Kellgren/Lawrence grade ≥2 on radiographic images of the knee or hip area with joint pain. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for osteoarthritis according to the severity of periodontitis, stratified by type 2 diabetes mellitus, were calculated using multiple logistic regression analyses.Participants with type 2 diabetes mellitus were more likely to have osteoarthritis as the severity of periodontitis increased (nonsevere periodontitis OR 1.23 [95% CI 0.67-2.32]; severe periodontitis OR 3.01 [95% CI 1.51-5.84]) after adjusting for age, sex, body mass index, smoking status, alcohol consumption, regular exercise, education level, household income, hypertension, and frequent tooth-brushing. However, this positive association was not found in individuals without type 2 diabetes mellitus after adjusting for the same covariables.Severe periodontitis was positively and significantly associated with osteoarthritis in middle-aged and older individuals with type 2 diabetes mellitus. Our findings suggest that the oral inflammation manifesting in periodontitis may be at least partly involved in the pathogenesis of osteoarthritis, particularly in patients with type 2 diabetes mellitus.

Hepatic steatosis (HS) is a growing problem in adults worldwide, with racial/ethnic disparity in the prevalence of the disease. The purpose of this study was to characterize the racial/ethnic prevalence of the stages (normal/mild [S0/S1], moderate [S2], and severe [S3]) of HS in Mexican Americans and other Hispanics compared to other racial/ethnic groups. We analyzed data for 5,492 individuals 12 years and older from the newly released National Health and Nutrition Examination Survey 2017‐2018, which is a representative sample of the US adult population. HS was diagnosed by FibroScan using controlled attenuation parameter values: S0, 290. We analyzed the data using the bivariate chi‐squared test and multinomial regression. The prevalence of HS overall was 46.9% (S2,16.6%; S3, 30.3%). The prevalence of S3 was highest among Mexican Americans (42.8%), lowest among Blacks (21.6%), 27.6% in other Hispanics, and 30.6% in Whites (P, Hepatic steatosis is a growing global epidemic that it has long been thought that Hispanics are at higher risk for hepatic steatosis than other racial/ethnic groups.However, previous studies have often not taken the diverse ethnic origins of Hispanics into account.Our study shows that particularly Hispanics of Mexican descent are at increased risk for hepatic steatosis, while Hispanics of non‐Mexican descent are not.

We develop a generalized partially additive model to build a single semiparametric risk scoring system for physical activity across multiple populations. A score comprised of distinct and objective physical activity measures is a new concept that offers challenges due to the nonlinear relationship between physical behaviors and various health outcomes. We overcome these challenges by modelling each score component as a smooth term, an extension of generalized partially linear single-index models. We use penalized splines and propose two inferential methods, one using profile likelihood and a nonparametric bootstrap, the other using a full Bayesian model, to solve additional computational problems. Both methods exhibit similar and accurate performance in simulations. These models are applied to the National Health and Nutrition Examination Survey (NHANES) and quantify nonlinear and interpretable shapes of score components for all-cause mortality.

AIM The global burden of chronic liver disease is substantial. Limited studies have reported the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and liver fibrosis among middle-aged and older people. Therefore, we aimed to determine the nationwide prevalence of and associated factors for MAFLD and fibrosis in adults aged 45-79 years from the United States. METHODS This cross-sectional study utilized data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey conducted with a nationally representative sample of the civilian, noninstitutionalized US population. Hepatic steatosis and fibrosis were assessed by transient elastography with controlled attenuation parameter and liver stiffness measurement, respectively. RESULTS A total of 1186 eligible participants aged 45-79 years were finally included in the analyses. The estimated prevalence of MAFLD, significant fibrosis (F ≥ F2), and advanced fibrosis (F ≥ F3) was 48.6% (95% confidence interval [CI], 43.1%-54.0%), 9.5% (95% CI, 6.8%-12.7%), and 6.7% (95% CI, 4.1%-10.1%), respectively. Multivariable logistic regression revealed an increased MAFLD predisposition in subjects with metabolic disorders including overweight/obesity, abdominal obesity, hypertension, and diabetes mellitus. Moreover, the presence of depression was an independent and strong predictor of MAFLD risk (odds ratio = 3.23; 95% CI, 1.37-7.11). Elevated liver enzymes, hypertension, diabetes mellitus, hepatitis virus infection, and steatosis were associated with a high risk of significant fibrosis. CONCLUSIONS Newly defined MAFLD is highly prevalent in the US middle-aged and older population. Approximately 1 in 10 people has significant liver fibrosis. In addition to metabolic disorders, the presence of depression potentially increases the risk of MAFLD.

BACKGROUND Recess has been shown to increase total daily energy expenditure, which may favorably impact body mass index by decreasing adiposity. This study examines associations between recess participation and adiposity. METHODS The study sample included male (N = 1434) and female (N = 1409) children 5 to 11 years of age participating in the 2013-2016 National Health and Nutrition Examination Survey. Overweight and obesity were defined using age- and sex-specific percentiles. Recess participation interview questions were answered via proxy response. RESULTS Compared to a referent group participating in recess 5 days/week for >30 minutes/day and independent of demographic and behavioral factors, analysis revealed significantly greater odds of obesity in females reporting no recess participation (odds ratio 1.80; 95% confidence interval, 1.03-3.15, p = .03). Furthermore, minority females were consistently found to possess greater odds of overweight and obesity independent of recess participation time. Only Mexican American boys were found to have greater odds of obesity independent of participation recess time. CONCLUSIONS In a large nationally representative sample of US children, reporting no recess was associated with significantly greater odds of obesity in females. Minority females were also more likely to be overweight and obese and Mexican American boys are more likely to be obese independent of recess participation time.

Background Cognitive impairment and poor oral health are frequently seen among older adults. Both conditions have been identified as risk factors for mortality. However, the combined associations of cognitive impairment and poor oral health with mortality have not been well studied and are therefore the aim of this cohort study. Methods We analyzed data from the National Health and Nutrition Examination Survey (1999-2002) linked with mortality data obtained from the 2015 public-use linked mortality file. Cognitive impairment was defined as a digit symbol substitution test score lower than the lowest quartile. Oral health status was assessed based on presence of untreated caries, moderate to severe periodontitis, and edentulism. The combined effects of caries/periodontitis or edentulism and cognitive impairment on all-cause and cardiometabolic mortality were examined using the Cox proportional hazard models after adjusting for potential confounders including demographic characteristics, lifestyle, biomarkers, and comorbidities. Results In total, 1,973 participants were enrolled in the prospective study. At a median follow-up of 13.4 years, 978 participants had died (264 deaths due to cardiometabolic disease). Cognitive impairment, periodontitis, and edentulism were each found to be significant predictors of all-cause mortality. Caries, however, was not significantly related to mortality. When analyzing these predictors in combination, a diagnosis of cognitive impairment and periodontitis was associated with an 83.1% increase in all-cause mortality risk and an 87.7% increase in cardiometabolic mortality risk compared with healthy controls. Similarly, the risk for all-cause mortality was highest in cases where impaired cognition and edentulism co-occurred (adjusted hazard ratio = 1.701, 1.338-2.161). Conclusion Concomitant presence of cognitive impairment and periodontitis or edentulism can be associated with a higher risk of mortality among older U.S. adults. This article is protected by copyright. All rights reserved.

BACKGROUND AND AIMS Despite prescribing declines between 2011 and 2019, opioid morbidity and mortality in the United States continued to rise during this period. We estimated the relationship between opioid prescribing, opioid use disorder (OUD) and fatal opioid overdose in the United States. DESIGN Dynamic Markov model. SETTING United States, using data from the National Survey on Drug Use and Health, Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey and National Epidemiologic Survey on Alcohol and Related Conditions III. PARTICIPANTS Simulated US individuals 12+ years of age from the general population or with prescription opioid medical use, prescription opioid non-medical use, illicit opioid (e.g. heroin, illicit fentanyl) use, prescription OUD, illicit OUD with a history of prior prescription opioid non-medical use or non-fatal or fatal opioid overdose. MEASUREMENTS Active OUD cases and fatal prescription opioid overdoses. FINDINGS Between 2010 and 2019, opioid prescribing declined 42.5%. Although fatal opioid overdoses increased by 103.2%, these reductions in opioid prescribing averted an estimated 9600 [95% uncertainty interval (UI) = 7205, 15 478] deaths starting in 2011 relative to continued prescribing at 2010 levels-and are projected to avert another 50 918 (95% UI = 38 829, 79 795) overdose deaths between 2020 and 2029. The median time from initial opioid prescription to fatal opioid overdose was 5.2 years. Of the 2.4 million (95% UI = 2.2 million, 2.7 million) individuals in the United States with estimated active OUD in 2019, 65% (95% UI = 59%, 71%) were attributable to initial opioid use occurring prior to 2011, whereas 14% (95% UI = 12%, 17%) were attributable to initial opioid use occurring between 2017 and 2019. The impact, by 2029, of additional reductions in prescribing initiated in 2020 would be more than three times greater than that of similar reductions initiated in 2025. CONCLUSIONS Observed reductions in opioid prescribing volume in the United States from 2010 to 2019 appear to have saved approximately 9600 lives by 2019 and are anticipated to avert more than 50 000 fatal overdoses by 2029.

Background Non-alcoholic fatty liver disease (NAFLD) has high morbidity and mortality related to cardiovascular disease (CVD), but statins have been historically underutilised in these patients due to concern for hepatotoxicity. Aims To characterise trends in statin use among individuals with NAFLD and to determine predictors of statin utilisation in this population. Methods Individuals with NAFLD were identified from 2005 to 2018 continuous National Health and Nutrition Examination Survey. Trends in statin use over time were assessed, and predictors of statin under-utilisation for primary prevention were identified. The roles of a known diagnosis of liver disease and disease severity were examined. Results We included 14 113 individuals; 34.6% had NAFLD, of whom 5.4% reported a liver disease diagnosis. There was a significant increase in statin use for primary prevention between 2005 and 2018 (18.1%-25.0%; P = 0.03), but guideline-indicated use for this purpose was low (54.5% between 2005 and 2012; 48.6% between 2013 and 2018). A known NAFLD diagnosis was a negative predictor of statin use during the earlier time period but not more recently. Utilisation did not decrease with increasing liver disease severity. Conclusions In a nationally representative population with NAFLD, statin use for primary prevention has increased over time, but guideline-concordant use remains low. A known liver disease diagnosis was associated with lack of statin use in the earlier time period but not more recently, suggesting a changing perspective of underlying liver disease impacting statin utilisation. Further work to improve guideline-indicated statin use in this high-risk population is needed.

Understanding the burden of NAFLD among adolescents and young adults has become increasingly relevant. Our aim was to estimate the prevalence of NAFLD among adolescents and young adults in the United States. Data were obtained from National Health and Nutrition Examination Survey from 2007‐2016. Adolescents and young adults aged 12 to 29 years were included. NAFLD was determined by the U.S. Fatty Liver Index in the absence of secondary causes of liver disease, and the differences in prevalence trends were analyzed based on age, gender, and race. Complete data were available for 4,654 adolescents and young adults (mean age 21 years; 50.9% male; 56.8% White, 20.9% Hispanic, and 13.3% Black). The overall prevalence of NAFLD among adolescents and young adults was 18.5%, ranging from 13.2% among early and middle adolescents (12‐17 years) to 18.7% among late adolescents and young adults (18‐24 years), to 24.0% among older young adults (25‐30 years) (trend P 0.80). In contrast, NAFLD prevalence among late adolescents increased (trend P = 0.018). In fact, White and Hispanic late adolescents were the drivers behind this increase in the prevalence of NAFLD. Conclusion: These data indicate an increasing trend in NAFLD prevalence among 18‐24‐year‐olds. These data have important public health and policy implications., Over the past decade, the prevalence of NAFLD among the youth (12‐29 years old) is increasing primarily among the 18‐24‐year‐old age group. This increase is partly driven by increases among young Hispanic males. We also found the prevalence of complications of obesity such as insulin resistance and hyperlipidemia parallels that of NAFLD.

Background Skeletal muscle mass begins to decline from 40 years of age. Limited data suggest that dietary fibre may modify lean body mass, of which, skeletal muscle is the largest and most malleable component. We investigated the relationship between dietary fibre intake, skeletal muscle mass, and associated metabolic and functional parameters in adults aged 40 years and older. Methods We analysed cross-sectional data from the US National Health and Nutrition Examination Survey between 2011 and 2018 from adults aged 40 years and older. Covariate-adjusted multiple linear regression analyses were used to evaluate the association between dietary fibre intake and body mass components (body mass, BMI, total lean mass, appendicular lean mass, bone mineral content, total fat, trunk fat; n = 6454), glucose homeostasis (fasting glucose, fasting insulin, HOMA2-IR; n = 5032), and skeletal muscle strength (combined grip strength; n = 5326). Body mass components and skeletal muscle strength were expressed relative to body mass (per kg of body mass [BM]). Results Higher intakes of dietary fibre were significantly associated with increased relative total lean mass (β: 0.69 g/kg BM; 95% CI, 0.48 to 0.89 g/kg BM; P

The aim was to compare the metabolic syndrome in adults with and without depression in Korea using the 2013–2015 Korea National Health and Nutrition Examination Survey. A cross‐sectional study was conducted involving secondary data analysis. National survey data on the self‐reported medical diagnosis of depression and metabolic syndrome were collected between 2013 and 2015 and released for research purposes in 2017. We conducted a propensity score‐matched study that included adults (n = 494) with and without depression at a 1:1 ratio, to reduce the impact of potential confounding factors between groups. Depression was not significantly associated with changes in metabolic syndrome. However, participants with depression had significantly higher triglycerides than those without depression (p = .008), highlighting the importance of periodically checking triglycerides in depressed patients. Nurses need to check the subcomponents of metabolic syndrome in depressed patients periodically, especially regarding the management of triglycerides.

Aim We aimed to investigate the association between low muscle mass (LMM) and metabolic syndrome (MetS) according to the definition of LMM. Methods This study used data from the Korean National Health and Nutrition Examination Survey conducted from 2008 to 2011. We used appendicular skeletal muscle adjusted for height (ASM/Ht2 ) and weight (ASM/Wt) as definitions of LMM. Class I and Class II LMM were defined as ASM/Ht2 or ASM/Wt from 1 to 2 standard deviations (SDs) or 2 SDs below the mean for young adults, respectively. Results A total of 6370 participants were included in analysis: 58.5% were women. The mean age of participants in this study sample was 72.3 ± 4.8 years. In the fully adjusted model, ASM/Ht2 was inversely related to MetS prevalence (adjusted odds ratio [aOR] 0.770, 95% confidence interval [CI] 0.600-0.988 for class I, aOR 0.473, 95% CI, 0.327-0.684 for class II). In contrast, MetS prevalence increased in class I (aOR 1.902, 95% CI 1.510-2.396) and class II LMM (aOR 2.831, 95% CI 2.194-3.655) using ASM/Wt. ASM/Ht2 was proportional to the waist circumference and the number of metabolic features, whereas ASM/Wt was inversely proportional in both sexes. Stratified analysis showed that the association was robust regardless of the cardiovascular risk factors. Conclusion In Korean older adults, ASM/Wt is positively associated with MetS prevalence, whereas ASM/Ht2 is inversely associated, regardless of the cardiovascular risk factors. Waist circumference and the number of metabolic features were directly proportional to ASM/Ht2 , but inversely proportional to ASM/Wt. Geriatr Gerontol Int 2021; ••: ••-••.

Background Ultra-processed foods are associated with both sugar intake and noncommunicable diseases. We aimed to assess whether the intake of ultra-processed food is associated with periodontal disease and whether this association, if present, is dependent on non-communicable diseases. Methods This analysis used data from cycles 2009-2010, 2011-2012 and 2013-2014 of the National Health and Nutrition Examination Survey (NHANES), including participants aged 30 years or older. Dietary recalls were categorized according to the NOVA classification, and total contribution of ultra-processed foods to daily energy intake (%E) was calculated. Cases of periodontitis were defined as moderate or severe according to the CDC working group criteria for use in population surveillance of periodontitis. Adjustment variables to estimate total and direct associations were defined with direct acyclic graphs. Odds ratios were estimated with logistic regression for moderate/severe periodontitis and severe periodontitis, and ordinal logistic regression for the trichotomised outcome. Analyses were done using NHANES fasting subsample weights. Results Sample participants numbered 4809 (52.2% female), with a mean age of 52.1 years (SE, 0.3). The prevalence of periodontal disease was 27.8% for moderate and 6.5% for severe cases. Mean %E from ultra-processed foods was 54.4 (SE, 0.5). No significant crude, direct or total association between ultra-processed %E and periodontal disease was found. Conclusion Intake of ultra-processed foods is not associated with periodontal disease in US non-institutionalized adults over 30 years old, whether directly or by mediation. This article is protected by copyright. All rights reserved.

Objectives To estimate the association between the use of interdental cleaning devices and proximal caries experience. Methods This study used a cross-sectional data from the Sixth Korea National Health and Nutrition Examination Survey (2013-2015). A total of 13 525 adults aged 19-64 years who participated in both the nutrition survey and the health examination survey were included. Data on sociodemographic factors (age and sex), socioeconomic factors (level of education and household income) and personal health practices (frequency of toothbrushing, visits to dental clinic, frequency of snacking and self-rated oral health status), and number of proximal caries were collected. Prevalence ratios (PRs) and 95% confidence intervals (95% CI) were calculated using the multivariable Poisson generalized linear model according to use of dental floss or an interdental brush. The risk of proximal caries for dental floss following the stratification of participants into various subgroups related to oral health was assessed. Results While nonflossers had 1.46 times (PR 1.46, 95% CI: 1.16-1.84) higher risk for proximal caries than flossers, the use of an interdental brush was not associated with proximal caries. In the nonflossers, the association for proximal caries was the strongest in those in their 40s (PR 2.28, 95% CI: 1.29-4.03), followed by those in their 30s (PR 1.85, 95% CI: 1.18-2.90). Although nonflossers with middle-low household income had a 59% higher risk (PR 1.59, 95% CI: 1.24-2.03) for proximal caries than those with high household income, there were no significant differences in household income in flossers. Conclusions The findings of the study suggest that flossing at home along with toothbrushing is one of the easiest ways to prevent proximal caries. Therefore, dental floss should not be excluded from oral healthcare products.

Objectives Allostatic load (AL), defined as the overtime "wear and tear" on biological systems due to stress, disproportionately affects racial/ethnic minorities and has been shown to associate with racial inequality in oral health in the adult population. This study aims to assess racial/ethnic inequality in AL and untreated dental caries (UD) in children, and to assess the association between allostatic load and UD, and whether it varies by race/ethnicity. Methods Data from the National Health and Nutrition Examination Survey (NHANES) (2001-2010) for 8-17-year-old children (n = 11,378) was used. AL scores were generated using cardiovascular, metabolic and immune biomarkers. Multivariable log binomial regression models adjusted for age, sex, poverty: income ratio (PIR), health insurance status and the frequency of healthcare visits, were used to assess the relationships of interest. Results Racial/ethnic inequality was evident in UD and AL, where Mexican American and black children exhibited more UD and a higher AL score than white. AL was associated with UD in fully adjusted models. This association was significant across all racial/ethnic groups, but was stronger in Mexican American and black children, compared to their white counterparts. Conclusions Similar racial inequality is evident in AL and UD that is not explained by poverty and/or behavioral factors. Racial/ethnic inequality is also evident in the association between AL and UD.

OBJECTIVES Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit-and-fissure sealant placement, among children in the United States, ages 6-18 years. METHODS A cross-sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013-2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6-18 years, had been evaluated for pit-and-fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country

BACKGROUND Alcohol use and alcohol-associated liver disease (ALD) burden are increasing in young individuals. AIM To assess host factors associated with this burden. METHODS National Health and Nutrition Examination Survey (NHANES), National Inpatient Sample (NIS), and United Network for Organ Sharing (UNOS) databases (2006-2016) were used to identify individuals with harmful alcohol use, ALD-related admissions, and ALD-related LT listings respectively. RESULTS Of 15 981 subjects in NHANES database, weighted prevalence of harmful alcohol use was 17.7%, 29.3% in

Objective The purpose of this study was to investigate oral health status and oral health behaviors in elderly Koreans with periodontal disease. Methods The data of the Seventh Korea National Health and Nutrition Examination Survey (2016-2018) were used. This cross-sectional study included 2981 individuals who were at least 65 years of age. Periodontal disease was assessed in oral health exams. Subjective oral health status (e.g., toothache) and oral health behaviors (e.g., tooth brushing and oral health examination) were assessed in health interviews. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression. Results The overall prevalence of periodontal disease in the study population was 47.5%. Individuals with periodontal disease were more likely to have a toothache than those without periodontal disease (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] = 1.20-1.77). Individuals with periodontal disease were also more likely to have chewing discomfort (aOR = 1.21, 95% CI = 1.01-1.44) and less likely to use oral hygiene products (aOR = 0.74, 95% CI = 0.60-0.91) than those without periodontal disease. Conclusions About half of elderly had the periodontal disease. Elderly Koreans with periodontal disease were more likely to have poor oral health and behavior than those without periodontal disease. The results of this study provide an insight into social and behavioral factors associated with periodontal diseases in older Koreans. It is necessary to confirm these results through prospective studies.

Background So far, studies on the association between sleep and periodontitis have shown conflicting results. This study assessed the association among sleep duration, sleep time, and periodontitis among a nationally representative Korean population and the mediation effect of WBC. Methods We analyzed data from the Seventh Korean National Health and Nutrition Examination Survey (KNHANES VII) collected from 2016 to 2018. With the screenings by age (45 to 64), edentate, and the adequacy of information provided, the analysis was confined to a selected group of respondents of 4407 with measurements for the sleep survey and periodontal health status out of total 24,269. Periodontitis was defined according to the World Health Organization's community periodontal index (CPI) code greater than or equal to three, and severe periodontitis was defined as CPI code 4. Multivariable logistic regression analysis was used to test the association between sleep and periodontitis controlling the confounding factors. Results Those who went to bed during the daytime were associated with periodontitis (OR = 1.49, 95% confidence interval [CI]: 1.07 to 2.07). In a combined sleep time and duration model, those who went to bed at night with a sleep duration of 9 hours or more were associated with periodontitis (OR = 1.69, 95% CI: 1.04 to 2.77) and severe periodontitis (OR = 1.88, 95% CI: 1.02-3.45). WBC count had the highest impact on the association between sleep time and periodontitis. Conclusions Our findings suggest that an extra-long sleep duration and going to bed during the daytime are associated with periodontitis.

Previous analyses within the National Health and Nutrition Examination Survey (NHANES) II and III cycles suggested an association between blood lead levels (BLLs) and lung cancer mortality, although the evidence was limited by small case numbers. To clarify this relationship, we conducted updated analyses of 4,182 and 15,629 participants in NHANES II and III, respectively, (extending follow‐up 20 and 8 years) aged ≥20 with BLL measurements and mortality follow‐up through 2014. We fit multivariable Cox models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) relating BLLs and lung cancer with adjustment for smoking and other factors. We did not observe an overall association between BLLs and lung cancer after adjustment for smoking (both surveys) and serum cotinine and environmental tobacco smoke exposure (NHANES III), although suggestive associations were observed among women (NHANES II: HR 2.7, 95% CI 0.7, 10.0 for ≥20.0 µg/dl vs.

Few studies have examined the association of serum selenium with anemia‐related indicators and risk of anemia. We conducted a cross‐sectional analysis of 2,902 adults in 2003–2004 National Health and Nutrition Examination Survey database. Multivariable linear and logistic regression models were used to examine the association of serum selenium with anemia‐related indicators and risk of anemia. The nonlinear relationship was analyzed using a generalized additive model with the smoothing plot. A total of 1,472 males and 1,430 females with a mean age of 61.94 ± 13.73 years were included. Compared with the lowest quintile, the highest quintile of serum selenium was associated with increased level of serum iron (β = 12.44, 95% confidence interval [CI]: 7.14, 17.75, p, Higher serum selenium is associated with an increased serum iron level, MCHC, and hemoglobin level and a decreased risk of anemia. Due to the narrow physiological range of selenium, the relationships between selenium‐ and anemia‐related indicators and risk of anemia were nonlinear. Our findings would provide new insights on selenium nutrition that implicate anemia and human health.

OBJECTIVES: To examine oral cancer screening rates and associated factors among adults with periodontal disease (PD). We hypothesized that adults with severe PD will be less likely to report receipt of any type of oral cancer screening than adults with no PD. MATERIALS AND METHODS: We used 2011-2014 National Health and Nutrition Examination Survey (NHANES) data on adults ≥ 30 years. PD status was classified as no PD, mild/moderate PD, and severe PD. Survey-adjusted logistic regression analysis was used to examine the model adjusted risk ratio (RR) and 95% confidence intervals (CI) for the outcome of not receiving intraoral, extraoral or both types of oral cancer screenings among adults with PD. Control variables included age, sex, race/ethnicity, health insurance, education, income level, smoking status, alcohol use and last dental visit. RESULTS: The analytic sample included 6962 adults weighted to the national population of adults who had a periodontal examination during 2011-2014. Overall 31.5%, 26.8% and 20.9% of adults reported receipt of intraoral, extraoral, and both types of oral cancer screening, respectively. Almost 40% of adults had some form of PD (7.6% severe, and 32.4% mild/moderate PD). A higher proportion of 45-64-year-olds, males, non-Hispanic Blacks, those with less than high school education, with income level less than 200% federal poverty level, or those with no insurance had severe PD than no PD. In adjusted analyses, adults with severe PD were significantly more likely to report no receipt of intraoral (RR= 1.25, 95% CI = 1.12-1.40), extraoral (RR = 1.17, 95% CI = 1.07-1.27) or both types of oral cancer screenings (RR= 1.18, 95% CI = 1.10-1.27) than those with no PD. CONCLUSIONS: Significantly low proportion of adults age ≥ 30 years with severe PD reported receiving any type of oral cancer screening. The association between PD and risk of oral cancers points to the need to improve oral cancer screening rates among adults with PD.

Objective Rheumatoid arthritis (RA) and chronic obstructive pulmonary disease (COPD) are both chronic inflammatory diseases; the prevalence of COPD in RA patients is known to be high. However, the prevalence of both RA and COPD differs according to sex; the relationship between RA and COPD may also vary according to sex. Therefore, we investigated the prevalence of COPD and its association in patients with RA in Korea by sex. Methods We conducted a nationwide cross-sectional study using data from the Korea National Health and Nutrition Examination Survey. A total of 12 417 men and 15 878 women were included. In this study, RA was defined as physician diagnosed or currently under RA treatment. COPD was defined based on spirometry results, chronic symptoms, and smoking history. Multivariable logistic regression models were employed and we calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for COPD prevalence in patients with RA. Results The prevalence of COPD was 15.5% in men with RA, 3.5% in women with RA, 7.8% in men without RA, and 2.2% in women without RA. After adjustment for potential confounding variables, including smoking status, RA was significantly associated with COPD in men (OR 2.16, 95% CI 1.06-4.40), but not in women (OR 1.58, 95% CI 0.81-3.10). Conclusions In Korea, the prevalence of COPD was high in patients with RA of both sexes; RA and COPD was significantly likely to be associated in men, but not in women.

AIM We aimed to determine whether both hands should be tested for handgrip strength and whether it is necessary to perform repeated measurements in each hand. METHODS The data were obtained from the Korea National Health and Nutrition Examination Survey conducted from 2014 to 2018. The participants performed three trials of handgrip strength measurement for each hand alternately, with 60-s rest between the trials. From this pool of data, we included 23 901 participants aged ≥19 years who had completed surveys on the handgrip strength test, and obtained their medical history. RESULTS The dominant hand had a significantly stronger handgrip strength than the non-dominant hand (32.75 ± 0.10 vs. 30.95 ± 0.09 kg, P

OBJECTIVE To assess whether proportional contribution of unprocessed or minimally processed, processed or ultra-processed foods to daily energy intake is associated with dental caries in US adults. METHODS This secondary cross-sectional analysis included adults aged 20 to 59 years old with complete oral examinations, using data gathered from cycles 2011-2012 and 2013-2014 of the continuous National Health and Nutrition Examination Survey (NHANES). Dietary recall data were categorized according to the NOVA classification into four groups: unprocessed or minimally processed foods (Group 1), processed culinary ingredients (Group 2), processed foods (Group 3) and ultra-processed foods (Group 4). The proportional contribution of each of these groups to mean daily energy intake was calculated and then cut into quartiles (Group 1, Group 3 and Group 4) or tertiles (Group 2). Two separate measures were used to assess dental caries: the decayed, missing, filled teeth (DMFT) index and, after exclusion of edentulous participants, prevalence of untreated caries. Poisson regression was used to model DMFT, while logistic regression was used to model the prevalence of untreated dental caries. Models were calculated for each NOVA group. All models were controlled for age, gender, race/ethnicity, level of education, income, access to oral health services, body mass index, smoking status and total energy intake. Analyses took into account NHANES sampling weights. RESULTS We analysed data from 5720 individuals, of whom 123 (2.2%) were edentulous. Mean DMFT was 9.7 (± 0.2), while the prevalence of untreated dental caries was 26.0%. Mean daily energy intake was 2170 kcal (± 17). Mean contribution to overall daily energy intake was 28.6% (± 0.5) for G1 foods, 4.3% (± 0.1) for G2 foods, 10.1% (± 0.2) for G3 foods and 56.9% (± 0.5) for G4 foods. A higher intake of G3 was associated with lower DMFT at the fourth quartile (0.89; 95%: CI 0.81-0.96), while a higher intake of G4 was associated with a higher DMFT at the fourth quartile (1.10; 95% CI: 1.04-1.16). In the adjusted models for untreated dental caries, no statistically significant associations were found with any of the NOVA groups. CONCLUSION Higher proportional intake of NOVA groups is only weakly associated with dental caries. Widespread exposure to a highly ultra-processed diet may explain these weak associations.

Objective The purpose of this study was to investigate the association of sodium intake with obesity in US children and adolescents. Methods Cross-sectional data were analyzed for 9,026 children and adolescents in the National Health and Nutrition Examination Survey (NHANES) 2009-2016. Usual sodium intake was estimated from 24-hour dietary recalls using a measurement error model. Logistic regression was used to assess the association of sodium intake with overweight/obesity, obesity, and central obesity (waist to height ratio [WtHR] ≥ 0.5; waist circumferences (WC) ≥ age- and sex-specific 90th percentile). Results Mean (SE) sodium intake was 3,010 (9) and 3,404 (20) mg/d for children and adolescents, respectively. The adjusted odds ratio (AOR) comparing Q4 versus Q1 (87.5th vs. 12.5th percentile of sodium intake) among children was 1.98 (95% CI: 1.19-3.28) for overweight/obesity, 2.20 (1.30-3.73) for obesity, 2.10 (1.12-3.95) for WC ≥ 90th percentile, and 1.68 (0.95-2.97) for WtHR ≥ 0.5, adjusting for demographics, energy, and sugar-sweetened beverage intake. Among adolescents, AOR was 1.81 (0.98-3.37) for overweight/obesity, 1.71 (0.82-3.56) for obesity, 1.62 (0.71-3.66) for WC ≥ 90th percentile, and 1.73 (0.85-3.50) for WtHR ≥ 0.5. Conclusions Sodium intake was positively associated with overweight/obesity, obesity, and central obesity among US children independent of energy and SSB intake, but the association did not reach significance among adolescents.

Higher dietary intake of calcium (Ca), magnesium (Mg), and vitamin D has been associated with reduced risk of type 2 diabetes (T2DM), and a higher intracellular ratio of Ca to Mg leads to insulin resistance. Previous epidemiological studies did not examine the combined effects of dietary Ca, Mg, and vitamin D as well as ratio of Ca to Mg with T2DM. Therefore, we assessed the relationship between dietary intakes of Mg, Ca, and vitamin D (using 24‐hr recalls) individually and in composite and T2DM in the National Health and Nutrition Examination Survey 2007–2014, which involved 20,480 adults (9,977 men and 10,503 women) with comprehensive information on related nutrients, and anthropometric, demographic, and biomarker variables using multivariable logistic regression. The results indicated that dietary calcium at Q3 (812 mg/day) was significantly linked with T2DM in women (OR: 1.30; 95% CI: 1.02, 1.65). Dietary vitamin D at Q3 (5.25 μg/day) significantly reduced the odds of T2DM by 21% in men (OR: 0.79; 95% CI: 0.64, 0.98). This is an interesting study that has important implications for dietary recommendations. It is concluded that US adults having dietary Ca below the RDA were associated with increased risk of T2DM in all population and women, while higher ratio of Ca to Mg was associated with increased risk of T2DM in all population and increased vitamin D intake is related to decreased risk of T2DM in men. Moreover, further research is needed to make more definitive nutritional recommendations., This is an interesting study that has important implications for dietary recommendations. It is concluded that dietary calcium intake level of 812 mg/day (Q3) will increase the risk of developing T2DM in the general population and women. Additionally, the findings conclude that US adults having dietary calcium below the RDA were associated with increased risk of T2DM in all population and women, while higher ratio of Ca to Mg was associated with increased risk of T2DM in all population and increased vitamin D intake was associated with decreased risk of T2DM in men. Moreover, the conclusions should probably call for more studies to confirm these results in other settings.

Background Clinical trials have demonstrated magnesium supplements to be effective for prophylactic treatment of migraine. Dietary magnesium intake of many Americans is known to be below nutritional recommendations, but typical magnesium intake from dietary sources in adults with migraine has not previously been evaluated. Objective This study aimed to quantify dietary and total (diet + supplement) magnesium consumption of adults with migraine or severe headache in the United States, and to investigate the relationship between magnesium consumption levels and prevalence of migraine or severe headache. Methods This analysis included cross-sectional data from 3626 participants, 20- to 50-years old in the National Health and Nutrition Examination Survey between 2001 and 2004. Presence of migraine or severe headache in the past 3 months was determined by questionnaire. Individuals responding affirmatively were classified as having migraine, and individuals reporting not experiencing migraine or severe headache were classified as controls. Dietary magnesium intake was determined from a 24-hour recall interview, supplemental magnesium intake was determined from the dietary supplements interview, and total magnesium intake was the sum of dietary and supplement intake. Results Mean dietary consumption of magnesium was below the recommended dietary allowance (RDA) for both migraine (n = 905) and control groups (n = 2721). Attainment of the RDA through a combination of diet and supplements was associated with lower adjusted odds of migraine (odds ratio [OR] = 0.83, 95% confidence intervals [CIs] = 0.70, 0.99, p = 0.035). Magnesium consumption in the highest quartile (Q) was associated with lower odds of migraine than in the lowest Q for both dietary (OR = 0.76, 95% CI = 0.63, 0.92, p = 0.006) and total (OR = 0.78, 95% CI = 0.62, 0.99, p = 0.042) magnesium intake in adjusted models. Conclusion These results suggest inadequate consumption of magnesium intake is associated with migraine in U.S. adults ages 20-50. Further prospective investigations are warranted to evaluate the role of dietary magnesium intake on migraine.

BACKGROUND Currently, weight loss remains the main management strategy for NAFLD, but the weight loss intention and methods remain poorly characterized. METHODS We analysed data about the perception of weight status, intention and methods to lose weight amongst 3,822 persons with NAFLD (United States Fatty Liver Index ≥ 30) from the National Health and Nutrition Examination Survey, 2001-2014. RESULTS Only 53.9% of people with NAFLD intended to lose weight, 91.8% with perception of overweight and 8.2% with normal weight perception. Persons with perception of overweight or overweight/obese status were four times more likely to try to lose weight (adjusted odds ratios 3.9 and 4.2, respectively, both P

Objective Physical activity (PA) and sedentary behavior (SB) have been linked to adult adiposity. This research aims to explore 10-year (2007-2016) trends in obesity and abdominal obesity prevalence and associations with different types of PA and SB among US adults. Methods National Health and Nutrition Examination Survey (NHANES) data were used with 20- to 64-year-old adults (n = 20,360; mean age: 41.9 years; male: 50.5%; non-Hispanic White: 64.3%). Sex- and sex- and race-specific linear trends in the prevalence of obesity, abdominal obesity, and moderate and vigorous work- and recreation-related PA and SB were estimated. Weighted logistic models explored the association between risk of obesity or abdominal obesity with each type of PA and SB by sex, adjusted for relevant confounders. Results There were significant increasing trends in obesity and abdominal obesity in both sexes and in Hispanic adults. Men at higher vigorous work-related PA levels (P = 0.045) and women at higher moderate recreational-related PA (P = 0.005) levels had decreased risk of abdominal obesity. Women at the highest versus the lowest level of SB had increased risk of abdominal obesity (P = 0.017). Conclusions There was a significantly reduced risk for abdominal obesity with a few types of PA among both sexes and an increased risk with SB among women only.

AIM To quantify exposure misclassification bias arising from use of partial-mouth protocols in studies of periodontitis-systemic disease associations. MATERIALS AND METHODS Using data from 10,134 adults participating in the National Health and Nutrition Examination Survey, we classified periodontal status based on full-mouth clinical examinations and three commonly used partial-mouth protocols. Associations between periodontitis and self-reported diabetes and cardiovascular disease were evaluated under each protocol using adjusted logistic regression. Percent relative bias was calculated to evaluate magnitude and direction of bias. RESULTS Misclassification primarily resulted in underestimation of associations, the extent of which depended on both the outcome under study and exposure severity. Bias due to misclassification of severe periodontitis was negligible for cardiovascular disease (0%-4.1%) compared to diabetes (177.7%-234.1%). In contrast, bias in moderate periodontitis associations was comparable across each outcome-diabetes (28.4%-39.5%) and cardiovascular disease (8.9%-46.7%). Results did not meaningfully change based on the partial-mouth protocol implemented. Stratified analyses showed increased bias among those with ≤15 teeth. Use of mean attachment loss as a continuous exposure resulted in minimal-to-no bias. CONCLUSIONS Exposure misclassification bias due to use of partial-mouth protocols can yield inaccurate conclusions about periodontitis-systemic disease associations, the extent of which may depend on periodontitis classification and the association under study.

AIM: To derive formulas to estimate the prevalence of untreated dental caries in permanent teeth based on the DMF index and lifetime caries prevalence. METHODS: Data from participants, aged 5 years or older, in the National Health and Nutrition Examination Survey 2011-2016 were analyzed. Dental caries was assessed at surface level with the Radike criteria, which matches the case definition of the Global Burden of Disease study. Participants' data were aggregated into 438 groups, based on survey strata and 5-year age brackets, to produce population estimates for the prevalence of untreated caries (DT > 0), DMFT, DMFS, DT, DS, and lifetime caries prevalence (DMFT>0). Conversion formulas were derived using fractional polynomials to characterize the association of each caries indicator with the prevalence of untreated caries. RESULTS: The mean prevalence of untreated caries was 23.5 percent (SD: 12.9 percent, range: 1.0-72.3 percent). After adjustment for age, the prevalence of untreated caries was correlated with DMFT (r = 0.23), DMFS (r = 0.25), DT (r = 0.74), DS (r = 0.65) and lifetime caries prevalence (r = 0.18). Using fractional polynomial models adjusted for categorical age, the prevalence of untreated caries at population level could be estimated from DMFT with power 1 (linear form), DMFS with power 0.5, DT with power 0.5, DS with powers (0.5; 1) and lifetime caries prevalence with power 1. CONCLUSION: The prevalence of untreated caries in permanent teeth can be estimated from the DMF index and lifetime caries prevalence. These conversion formulas can facilitate the inclusion of more studies in estimation of the global burden of untreated caries in permanent teeth.

BACKGROUND Olfaction and gustation are associated with age-related decline. Deficits in these chemosenses have been associated with significant comorbidities. Meanwhile, frailty, defined as a reduced physiological reserve, is well correlated with mortality and worse health outcomes. We sought to analyze a nationally representative patient population to determine the association between chemosensory dysfunction and frailty. METHODS Cross-sectional analysis of U.S. National Health and Nutrition Examination Survey (NHANES) 2013-2014 was performed, using multivariate logistic regression to examine the association between chemosensory dysfunction and frailty in adults aged ≥40 years (n = 3547). Self-reported olfactory dysfunction (sOD) and gustatory dysfunction (sGD), and measured olfactory dysfunction (mOD) and gustatory dysfunction (mGD) were assessed for all participants. Frailty was operationalized using a 39-item frailty index (FI) and stratified into 4 groups using validated cutoffs. RESULTS Participants with sOD and mOD had significantly higher mean FI scores (sOD: 0.18 vs 0.13, p < 0.001; mOD: 0.20 vs 0.14, p < 0.001), whereas subjects with sGD, but not mGD, had higher mean FI scores (sGD: 0.21 vs 0.13, p < 0.001; mGD: 0.14 vs 0.14, p = 0.953). Multivariate logistic regression demonstrated frail participants had significantly greater odds of sGD (odds ratio [OR] 4.11; 95% confidence interval [CI], 3.46 to 4.88), sOD (OR 2.35; 95% CI, 1.98 to 2.78), and mOD (OR 1.58; 95% CI, 1.22 to 2.05), but not mGD (OR 1.21; 95% CI, 0.91 to 1.61). This association was strongest in the frailest group. CONCLUSION Self-reported chemosensory dysfunction and mOD are independently associated with measures of frailty, suggesting a novel method to assess or predict frailty.

BACKGROUND This study examines the association of periodontitis with telomere length (TL) and effect modification by population characteristics. METHODS We analyzed data from 3,478 participants from the 1999 to 2002 National Health and Nutrition Examination Survey. Probing depth, attachment loss, and bleed on probing (BOP, available for 1,973 participants only) were examined on the distal, mesial, or mid-facial site of each tooth in two randomly selected quadrants. We defined periodontitis severity according to the Centers for Disease Control/American Academy of Periodontology guideline. TL from leukocytes was measured with qPCR. We used linear and logistic regression to examine the adjusted association of different severity of periodontitis and BOP with continuous TL (bp) and dichotomized short TL (

OBJECTIVES The purpose of this study was to identify the age, period and cohort effects on the changes in oral health status in South Koreans. METHODS The age, period and cohort analysis (APC analysis) of the oral health status was conducted using an aggregated age-by-time period table. The age-by-time period table was formulated using data from the Korea National Oral Health Survey (KNOHS) 2000 and 2006, and the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 and 2015. Two oral health outcomes were measured: the number of teeth and Decayed-Missing-Filled Teeth (DMFT) index. Descriptive analysis by graphical representation and partial least square (PLS) regression was used for APC analysis. RESULTS Both graphical description and PLS regression showed age and cohort effects in oral health status with the number of teeth decreasing and the DMFT index increasing with age. No period effects were found in either index. The number of teeth increased in the recent birth cohorts. However, the DMFT index showed a reverse J-shaped trend, which worsened in recent birth cohorts. The DMFT index increase in the recent cohort was mainly attributed by an increase in the FT index. CONCLUSIONS The effects of age on the number of teeth and caries highlight the importance of oral health in adulthood. The increased caries experience in recent cohorts may indicate the limitations of the current oral health policy. It would be relevant to explore what determinants cause the changes in oral health status. Future oral health policies should address the new directions to reduce the burden of oral diseases.

OBJECTIVE This study aimed to determine whether higher membrane capacitance (CM ), a bioelectrical measure of cell membrane function, is associated with insulin resistance (IR) and/or metabolic syndrome (MetS). METHODS Cross-sectional analyses were performed on 2,191 relatively healthy adults from the National Health and Nutrition Examination Survey. The CM of those with low/no disease risk was compared with those with IR, MetS, or both IR and MetS using ANCOVA. The associations between CM and related clinical measures were assessed with multiple linear regression. RESULTS Compared with those with low/no risk, women and men with IR (P