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Objective To describe the prevalence of breastfeeding and overweight in the Commonwealth of the Northern Mariana Islands (CNMI), and the relationship between the two. Design and Methods A random cluster survey of 420 children (aged 6 months to 10 years), was conducted in the CNMI in June and July of 2005. Children were measured for weight and height and caregivers were asked about past feeding habits by trained investigators. Results Seventy-three percent of children were ever breastfed; 53% were still breastfed at 6 months, and 22% at 1 year of age. Five percent of children were found to be underweight (<5th percentile), while 15% were at risk for overweight (85th to <95th percentile) and 19% were overweight (>95th percentile), according to the Centers for Disease Control and Prevention body mass index for age reference data. Children who had been breastfed had a substantially lower body mass index than children who had not breastfed, after adjusting for age, sex, birth-weight, and years of mother's education. Discussion These findings will be used to guide program development in the CNMI.

Body fat, especially in the upper body, has been associated with increased risk of chronic disease among adults. Factors associated with these traits among ethnically diverse populations are not well studied. We examined factors influencing body fat and weight among Asian and White adolescent girls from the female adolescent maturation longitudinal study (initial exam plus 2-y follow-up examination) in Hawaii. The objective of this study was to identify and compare influences on and differences in body size and fat distribution among Asian and White adolescent girls. Subjects were identified among age-eligible members of a large HMO. Of the 214 girls recruited for Exam 1, 107 girls returned for Exam 2. The girls' age, ethnicity, a 3-d diet record, and physical activity recall were obtained by questionnaire at both times, and Tanner pubic hair stage and anthropometry were clinically measured by trained staff at both exams. The ethnic proportion of the study sample was 57% Asian and 43% White. Each girl's ethnicity was based on the ethnic proportion of each biologic parent. The percentage of body fat was measured by Lunar Prodigy dual energy X-ray absorptiometry (DXA) at the follow-up exam only. Among various measures of skeletal size and adiposity, only leg length (inversely) and DXA trunk:peripheral fat ratio (directly) were associated with proportion of Asian ethnicity, after adjusting for age, Tanner pubic hair stage, physical activity, and energy intake. In a multivariate analysis focusing on the trunk:peripheral fat ratio, this measure of central obesity was positively associated with proportion of Asian ethnicity (P = 0.001) and bi-iliac breadth (P 0.002), and negatively associated with birth weight (P = 0.021), after adjustment for Tanner pubic hair stage, physical activity, energy intake, biacromial breadth, and height. In conclusion, Asian adolescents have a higher trunk:peripheral fat ratio than Whites. Adolescent bi-iliac breadth (positively) and birthweight (negatively) are associated with more body fat on the trunk vs. periphery during adolescence. KEY WORDS: * adolescent * ethnicity * DXA * Asian * trunk * fat

Background. Hepatitis A and B vaccines are effective in preventing superinfection and sequelae in patients with chronic hepatitis B or C. We describe immunity and vaccination against hepatitis A and B in chronic hepatitis patients from the US Chronic Hepatitis Cohort Study. Methods. We identified chronic hepatitis B and C patients with healthcare utilization during 2006–2008 and 12 months of enrollment. We used electronic laboratory records to determine immunity and medical and billing records for vaccination history. Immunity against hepatitis A was defined by positive hepatitis A antibody or documented vaccination. Immunity against hepatitis B was defined as hepatitis B surface antibody level ≥10 mIU/mL or core antibody positive, or by documented vaccination. Results. Among 1635 chronic hepatitis B patients, 978 (59.8%) were immune or vaccinated against hepatitis A, 122 (7.5%) had negative hepatitis A antibody tests, and 535 (32.7%) had no testing or vaccination record. Among 5328 chronic hepatitis C patients, 2998 (56.3%) were immune or vaccinated against hepatitis A, 659 (12.4%) had negative hepatitis A antibody tests, and 1671 (31.4%) had no testing or vaccination record. Additionally, 3150 (59.1%) chronic hepatitis C patients were immune or vaccinated against hepatitis B, 1003 (18.8%) had a negative test result, and 1175 (22.1%) were neither tested for nor vaccinated against hepatitis B. Conclusions. Approximately 40% of chronic hepatitis B and C patients are susceptible to or have no documented immunity or vaccination against hepatitis A or hepatitis B. Clinicians should consider antibody testing and vaccination for this vulnerable population. [ABSTRACT FROM AUTHOR]

Among persons in care during 2003–2010, we found that approximately 60% who tested positive for hepatitis C virus (HCV) antibody had a follow-up HCV RNA test to determine HCV infection status.Background. A test for hepatitis C virus (HCV) RNA is essential to identify persons with active, or current, HCV infection. We assessed trends in HCV RNA testing following a positive HCV antibody result among persons in 4 large healthcare organizations.Methods. Data collected from adults with ≥2 clinical encounters during 2003–2010 were analyzed to determine the frequency of, interval between, and factors associated with having an RNA test after a first positive HCV antibody test.Results. From 2003–2010, 5860 persons had a positive antibody test, of whom 3570 (60.9%) had a follow-up RNA test. During this period, the annual frequency of persons with an eventual RNA test did not change significantly; however, the fraction of persons who had the follow-up RNA test within 6 months improved significantly, from 45% in 2003 to 57% in 2010 (P < .001, for trend). Persons born during 1945–1965, men, and those with annual income <$30 000 (by census geocode) were less likely to have had a follow-up RNA test done within 6 months of a positive antibody test.Conclusions. Less than two-thirds of persons with a positive HCV antibody test had a follow-up RNA test. Rapid ascertainment of HCV infection status with reflex testing to RNA is critical to identify persons eligible for treatment. [ABSTRACT FROM AUTHOR]

The article focuses on the Chronic Hepatitis Cohort Study on the infection caused by the chronic hepatitis C virus (HCV) in the U.S. It states that the U.S. Centers for Disease Control and Prevention (CDC) has published guidelines for HCV testing. It mentions that the study followed patients with chronic HCV who receive care at health-care systems in the U.S. It reports that the survey data of the study analyzed that most initial HCV tests occurred in a physician's office.

Authors review 2 (FIB-4 and APRI) systems relying on more easily obtainable serum and cell biomarkers for liver biopsies to stage liver disease. This would be an important step in opening treatment and care of uncomplicated hepatitis C virus–infected patients.Background. Liver biopsy remains critical for staging liver disease in hepatitis C virus (HCV)–infected persons, but is a bottleneck to evaluation, follow-up, and treatment of HCV. Our analysis sought to validate APRI (aspartate aminotransferase [AST]–to-platelet ratio index) and FIB-4, an index from serum fibrosis markers (alanine aminotransferase [ALT], AST, and platelets plus patient age) to stage liver disease.Methods. Biopsy results from HCV patients in the Chronic Hepatitis Cohort Study were mapped to an F0–F4 equivalent scale; APRI and FIB-4 scores at the time of biopsy were then mapped to the same scale.Results. We identified 2372 liver biopsies from HCV-infected patients with contemporaneous laboratory values for imputing APRI and FIB-4. Fibrosis stage distributions by the equivalent biopsy scale were 267 (11%) F0; 555 (23%) F1; 648 (27%) F2; 394 (17%) F3; and 508 (21%) F4. Mean APRI and FIB-4 values significantly increased with successive fibrosis levels (P < .05). The areas under the receiver operating characteristic curve (AUROC) analysis distinguishing severe (F3–F4) from mild-to-moderate fibrosis (F0–F2) were 0.80 (95% confidence interval [CI], .78–.82) for APRI and 0.83 (95% CI, .81–.85) for FIB-4. There was a significant difference between the AUROCs of FIB-4 and APRI (P < .001); 88% of persons who had a FIB-4 score ≥2.0 were at stage F2 or higher.Conclusions. In a large observational cohort, FIB-4 was good at differentiating 5 stages of chronic HCV infection. It can be useful in screening patients who need biopsy and therapy, for monitoring patients with less advanced disease, and for longitudinal studies. [ABSTRACT FROM PUBLISHER]

Samoan women exhibit high rates of obesity, which can possibly be attenuated through diet and physical activity. Obesity, and body fatness in particular, is associated with increased risk for chronic diseases. Ancestry, physical activity, and dietary patterns have been associated with body composition. Using a cross-sectional design, the relative importance of proportion of Pacific Islander (PI) ancestry, level of physical activity, and macronutrients among healthy women in Honolulu, Hawai'i, ages 18 to 28 years was examined. All data were collected between January 2003 and December 2004. Percent body fat (%BF) was determined by whole body dual energy x-ray absorptiometry (DXA). Nutrient data were derived from a three-day food record. Means and standard deviations were computed for all variables of interest. Bivariate correlation analysis was used to determine correlates of %BF. Multiple regression analysis was used to determine relative contribution of variables significantly associated with %BF. Proportion of PI ancestry was significantly positively associated with %BF (P=0.0001). Physical activity level was significantly negatively associated with %BF (P=0.0006). Intervention to increase physical activity level of young Samoan women may be effective to decrease body fat and improve health. CRC-NIH grant: 0216. [ABSTRACT FROM AUTHOR]

Background: A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in "real world" settings are important to assess the implications of delaying HCV treatment., Methods: This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation., Results: Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0-F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma., Conclusions: The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease., (Published by Oxford University Press for the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Objectives: Asian and Pacific Islanders (APIs) constitute less than 6% of the US population, but account for more than half of Americans with chronic hepatitis B virus (HBV) infection. We sought to examine the effect of country of origin on HBV testing and chronic HBV infection prevalence among APIs., Methods: We analyzed demographic and clinical data collected for adults from Kaiser Permanente Hawaii with 1 or more healthcare encounters during 2006 to 2008, 12 months or more of follow-up before 2009, and no HBV-related diagnosis within 6 months of enrollment. Persons who received a test and a positive test result for HBV surface antigen or HBV DNA were classified "tested" and with "chronic HBV infection," respectively., Results: Of 92,687 eligible APIs, 53,573 (58%) had country-of-origin data available. Among those, 41,263 were US born; 28.3% were tested; and 1.8% of those tested had chronic HBV infection. Of 12,310 foreign-born APIs, 30.5% were tested and 7.4% of those tested had chronic HBV infection. Foreignborn APIs had higher odds of being tested (odds ratio [OR] = 1.15) and testing positive (OR = 4.18) compared with US-born APIs. Persons with 2 or more abnormal tests for alanine aminotransferase (ALT) levels had higher odds of getting tested (OR = 6.12) and of testing positive (OR = 1.86) compared with persons with other ALT levels., Conclusions: Less than one-third of this managed care API population (29% of 53,573) was tested, yet the prevalence of chronic HBV infection (3.2%) was 12 times higher than that of the general US population. These findings underscore the importance of adherence to HBV testing guidelines to identify persons with infection so they may be linked to care.

Birth size has important implications for health and disease in adulthood. This study examined the association of birth size with central body fat distribution in late adolescence. Data were from a cross-sectional survey of adolescent girls (N = 143, 13-18y) of Asian, White and Mixed Asian-white ethnicity collected in 2005-2007 in Hawai'i, USA. Central body fat distribution was assessed with dual-energy x-ray absorptiometry and birth size from birth certificates and parent recall. Food diaries (3-day) were used to determine energy intake and metabolic equivalents of energy expenditure. The proportion of Asian ancestry was determined by questions and anthropometry was performed. T-tests compared groups, and multiple regression examined predictors of central body fat distribution, adjusting for potential confounders. Asian girls had a lower mean weight and gestational age at birth than White girls, and a lower mean dietary fat intake in adolescence. Girls of Asian and Mixed Asian-white ancestry had a more body fat distribution than White girls. Lower birth weight was associated with greater central body fat distribution (0.1 or 10% higher central body fat distribution for every 10 grams lower birth weight), after adjusting for age, ancestry, physical activity, energy intake, and bi-iliac breadth, and gestational age. Further adjusting for birth length attenuated the birth weight effect, and shorter birth length was the significant predictor of central body fat distribution. (0.1 or 10% higher central body fat distribution for every 0.01mm shorter length). If confirmed, these findings would suggest that linear growth may be more relevant to metabolic programming than growth in mass.

Little is published about dietary intake of children of ethnic populations found in Hawai'i, due to an absence of national statistics collected on Hawai'i's population. This information is needed to focus planning of food, agriculture and health programs aimed to prevent obesity and related chronic disease and to improve health. Dietary patterns of 156 Native Hawaiian (n=110), Filipino (n=28) and White (n=18) children and their caregivers were compared using socio-demographic, annual "food season," and 24 hour dietary recall data from a baseline survey of four lower income communities selected for an intervention program in rural Hawai'i. Ethnic differences were found in the Healthy Eating Index (HEI) dairy component, and in calcium and vitamin C nutrient intakes among caregivers only (adjusting for food season). Whites always had higher intakes of these foods and nutrients than Filipinos or Native Hawaiians. Vitamin C intake remained significantly different among ethnic groups after further adjusting for dairy food group intake. Dietary patterns showed low intake of fruits and vegetables, fiber and dairy foods among these understudied populations.