Bone mineral density and verbal memory impairment: Third National Health and Nutrition Examination Survey.

Previous studies have examined the relation of endogenous estrogen levels or estrogen replacement therapy to the risk of poor cognitive function, but results have been inconclusive. Bone mineral density has been proposed as a marker for cumulative estrogen exposure. The authors studied the relation of bone mineral density to the prevalence of verbal memory impairment among 4,304 elderly subjects in the Third National Health and Nutrition Examination Survey (1988-1994). Bone mineral density was measured in five regions of the proximal femur with dual-energy x-ray absorptiometry. Verbal memory was assessed using delayed recall of a three-item word list and a six-item story. Verbal memory impairment was defined as a combined score of <4. The prevalence of verbal memory impairment for each increasing bone mineral density quintile at the femoral neck was 8.35, 5.74, 5.22, 5.00, and 3.38% in women and 11.54, 7.27, 8.47, 6.29, and 5.89% in men, respectively. With adjustment for age, sex, and other covariates, the prevalence ratios of verbal memory impairment for each increased bone mineral density quintile were 1.00, 0.64, 0.65, 0.55, and 0.44, respectively (p for trend < 0.001). These results suggest that bone mineral density in the elderly is associated with verbal memory impairment. The mechanisms underlying this relation are not understood, but cumulative exposure to estrogen may play a role.     

Bone mineral density and hypertension prevalence in postmenopausal women: results from the Third National Health and Nutrition Examination Survey

PURPOSE: We sought to corroborate a reported association of hypertension with bone mineral density (BMD) in postmenopausal women. METHODS: Data are from a nationally representative sample of 2738 women aged 50 years and older from the Third National Health and Nutrition Examination Survey. Total proximal femoral bone mineral density was measured by using dual-energy x-ray absorptiometry. Hypertension is defined as blood pressure of 140/90 mm Hg or greater or recent blood pressure medication use. RESULTS: Compared with the fourth quartile of BMD, age- and race-adjusted relative odds of hypertension were decreased in the first quartile (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.38-0.67; p < 0.01). However, the association was diminished and no longer significant after adjusting for body mass index (OR, 0.96; 95% CI, 0.69-1.36; p = 0.83) and additional risk factors in multivariate models (OR, 0.92; 95% CI, 0.65-1.30; p = 0.62). CONCLUSIONS: No association between hypertension and BMD was observed after controlling for body mass index and other confounders.     

Factors associated with low water intake among South Korean adolescents - Korea National Health and Nutrition Examination Survey, 2007-2010

Water is essential for life and plain water instead of sugar-sweetened beverages is one approach for decreasing energy intake. Due to limited data on characteristics associated with water intake among Korean adolescents, this study examined associations of demographic and behavioral characteristics with plain water intake by using nationally representative sample of South Korean adolescents. The data (2007-2010 Korea National Health and Nutrition Examination Survey) for 1,288 high school-aged adolescents (15-18 years) were used. Multivariable logistic regression was used to calculate adjusted odds ratios (OR) for factors associated with low water intake (< 4 cups/day) and very low water intake (< 2.5 cups/day). Nationwide, 38.4% and 19.0% of adolescents reported drinking water < 4.0 cups/day and < 2.5 cups/day, respectively. The mean plain water intake was 5.7 cups/day for males and 4.1 cups/day for females. Females had significantly higher odds for drinking water < 2.5 cups/day (OR = 2.2) than males, whereas adolescents with low milk consumption had significantly lower odds for drinking water < 2.5 cups/day (OR = 0.7). Factors significantly associated with a greater odds for drinking water < 4 cups/daywere being female (OR = 2.8) and not meeting physical activity recommendations (≥ 20 min/day on < 3 days/week) (OR = 1.6). Being underweight, overweight, and obese were significantly associated with reduced odds for drinking water < 4 cups/day (OR = 0.7, 0.4 and 0.5, respectively). However, intake of soda, coffee drinks, fruits, vegetables, and sodium and eating out were not significantly associated with low or very low water intake. These findings may be used to target intervention efforts to increase plain water intake as part of a healty lifestyle.     

Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents

Summary Background Cobalamin deficiency is prevalent in vegetarians and has been associated with increased risk of osteoporosis. Aim of the study To examine the association between cobalamin status and bone mineral density in adolescents formerly fed a macrobiotic diet and in their counterparts. Methods In this cross–sectional study bone mineral density (BMD) and bone mineral content (BMC) were determined by DEXA in 73 adolescents (9–15 y) who were fed a macrobiotic diet up to the age of 6 years followed by a lacto–(–ovo–) vegetarian or omnivorous diet. Data from 94 adolescents having consumed an omnivorous diet throughout their lives were used as controls. Serum concentrations of cobalamin, methylmalonic acid (MMA) and homocysteine were measured and calcium intake was assessed by questionnaire. Analysis of covariance (MANCOVA) was performed to calculate adjusted means for vitamin B₁₂ and MMA for low and normal BMC and BMD groups. Results Serum cobalamin concentrations were significantly lower (geometric mean (GM) 246 pmol/L vs. 469 pmol/L) and MMA concentrations were significantly higher (GM 0.27 µmol/L vs. 0.16 µmol/L) in the formerly macrobiotic–fed adolescents compared to their counterparts. In the total study population, after adjusting for height, weight, bone area, percent lean body mass, age, puberty and calcium intake, serum MMA was significantly higher in subjects with a low BMD (p = 0.0003) than in subjects with a normal BMD. Vitamin B₁₂ was significantly lower in the group with low BMD (p = 0.0035) or BMC (p = 0.0038) than in the group with normal BMD or BMC. When analyses were restricted to the group of formerly macrobiotic–fed adolescents, MMA concentration remained higher in the low BMD group compared to the normal BMD group. Conclusion In adolescents, signs of an impaired cobalamin status, as judged by elevated concentrations of methylmalonic acid, were associated with low BMD. This was especially true in adolescents fed a macrobiotic diet during the first years of life, where cobalamin deficiency was more prominent.     

Vitamin K status is associated with childhood bone mineral content

In adult bone, vitamin K contributes to bone health, probably through its role as co-factor in the carboxylation of osteocalcin. In children, the significance of vitamin K in bone-mass acquisition is less well known. The objective of this longitudinal study was to determine whether biochemical indicators of vitamin K status are related to (gains in) bone mineral content (BMC) and markers of bone metabolism in peripubertal children. In 307 healthy children (mean age 11.2 years), BMC of the total body, lumbar spine and femoral neck was determined at baseline and 2 years later. Vitamin K status (ratio of undercarboxylated (ucOC) to carboxylated (cOC) fractions of osteocalcin; UCR) was also measured at both time points. Markers of bone metabolism, sex steroids, vitamin D status and growth hormones were measured at baseline only. Large variations in the levels of the UCR were found at both time-points, indicating a substantial interindividual difference in vitamin K status. Improvement of vitamin K status over 2 years (n 281 children) was associated with a marked increase in total body BMC (r -49.1, P<0.001). The UCR was associated with pubertal stage, markers of bone metabolism, sex hormones and vitamin D status. A better vitamin K status was associated with more pronounced increase in bone mass in healthy peripubertal children. In order to determine the significance of these findings for childhood bone health, additional paediatric studies are needed.     

Hyperhomocysteinemia associated with poor recall in the third National Health and Nutrition Examination Survey

BACKGROUND: High circulating total homocysteine (tHcy) concentrations are associated with stroke, which is a major cause of cognitive dysfunction. Blood homocysteine concentrations are inversely correlated with performance on some cognitive-function tests and a relation was recently shown between hyperhomocysteinemia and Alzheimer disease. OBJECTIVE: The objective was to evaluate the relation between serum tHcy concentrations and performance on short delayed-recall tests of elderly men and women participating in the third National Health and Nutrition Examination Survey, phase 2 (1991--1994). DESIGN: Subjects were aged > or =60 y. Subjects reported no previous stroke, completed > or =8 y of education, and took a test of delayed recall of story ideas (n = 1200) or words (n = 1270). RESULTS: After adjustment for sex, age, race-ethnicity, income, years of education, and serum creatinine concentration, subjects in the upper half of the folate distribution recalled, on average, >4 of 6 story ideas; subjects with lower folate status recalled significantly fewer ideas (P < 0.001). Of the subjects with low folate status, story recall was significantly poorer in those with serum tHcy concentrations above the 80th percentile of the distribution (13.7 micromol/L) than in those with lower tHcy concentrations (P < 0.03). The odds ratio relating hyperhomocysteinemia to recall of > or =1 of 3 previously learned words was 0.3 (95% CI: 0.2, 0.7) after adjustment for the 5 demographic factors alone and was 0.4 (0.2, 0.9) after further adjustment for serum folate concentration. CONCLUSION: Hyperhomocysteinemia is related to poor recall and this association was partially independent of folate status.     

Dietary patterns of children and adolescents analyzed from 2001 Korea National Health and Nutrition Survey

The purpose of this study was to identify dietary patterns among children and adolescents in Korea and to examine their associations with obesity and some blood profiles. One day food consumption data measured by 24-hour recalls on 2704 subjects aged 1 to 19 were used from 2001 Korea National Health and Nutrition Survey. The data of blood profiles available in the ages of 10 or older was also used. After categorizing each food consumed into 29 food or food groups, five dietary patterns were derived through a factor analysis and subjects were classified into three major dietary patterns via a cluster analysis using the factor scores. Three dietary patterns were identified as ''traditional diet'' (25.6%), ''westernized-fast food'' (6.2%), and ''mixed diet'' (68.2%). The ''traditional diet'' pattern had a higher percentage in boys. Both the ''traditional diet'' and the ''westernized-fast food'' had higher proportions of adolescents (12-19 y) than younger children, while the ''mixed diet'' had a higher percentage of preschool children (1-5 y). Obesity rate analyzed within each age group showed no differences among 3 dietary pattern clusters. Blood pressure and all plasma profiles were not different among dietary patterns when adjusted with age and gender. Conclusively, children and adolescents in Korea had three distinct dietary patterns, which were associated with gender and age. These patterns could be useful to plan nutrition interventions for teenager health promotion.     

Vitamin B-12 status is associated with bone mineral content and bone mineral density in frail elderly women but not in men

Subclinical vitamin B-12 deficiency is common in the elderly. Encouraged by early indications, we investigated the plasma vitamin B-12 status in association with bone mineral content (BMC) and bone mineral density (BMD) in frail elderly people. Data of 194 free-living Dutch frail elderly (143 women and 51 men) were available. BMC and BMD were measured by dual energy X-ray analysis. Biochemical analyses were performed on plasma or serum including vitamin B-12, methylmalonic acid, homocysteine, 25-hydroxy vitamin D and parathyroid hormone. Women had higher plasma vitamin B-12 (288 and 238 pmol/L, respectively) and lower plasma homocysteine levels (15.8 and 21.3 micro mol/L, respectively) than men. Of the total explained variance of BMC and BMD in women (46 and 22%, respectively), 1.3-3.1% was explained by plasma vitamin B-12, in addition to weight and height or energy intake. In men, the variance of BMC and BMD was explained by weight, smoking and/or height (total R(2) was 53 and 25%, respectively), but not by plasma vitamin B-12. Osteoporosis occurred more often among women whose vitamin B-12 status was considered marginal or deficient than in women with a normal status, i.e., the prevalence odds ratios (after adjustment for weight, age and calcium intake) (95% confidence intervals) were 4.5 (0.8;24.8) and 6.9 (1.2;39.4), respectively. These results suggest that vitamin B-12 status is associated with bone health in elderly women. Future studies on bone health should take into account a possible role of vitamin B-12 status in different populations.     

Vitamin D status and its relationship with parathyroid hormone and bone mineral status in older adolescents

Osteoporosis is an important contributor to the global burden of disease, and in the UK alone results in one in three women and one in twelve men aged >50 years experiencing a fragility fracture. Optimising peak bone mass in early adulthood is thought to reduce osteoporosis risk by offsetting bone losses in later life. Ensuring sufficient vitamin D status (measured as 25-hydroxyvitamin D (25OHD) in plasma), among other factors, is believed to facilitate the achievement of optimum peak bone mass. Lower 25OHD is associated with a higher plasma concentration of parathyroid hormone (PTH). As PTH is associated with increased bone turnover and bone loss, maintenance of sufficient 25OHD is thought to have a protective effect on bone health. However, there is a lack of consensus internationally on what constitutes an optimum 25OHD concentration, and values between 30 and 80 nmol/l have been suggested. These values have been based on findings from various studies in adults in which PTH has been observed to plateau at a 25OHD concentration of >30 nmol/l; however, not all studies have found such a plateau. Although studies in younger adolescents (14-16 years) have shown an inverse relationship between PTH and 25OHD, the concentration of 25OHD required for achievement of optimum peak bone mass is unknown. The present review examines the evidence defining vitamin D insufficiency thresholds, and the relevance of such thresholds to adolescent bone health.     

Low bone mineral density, coronary heart disease, and stroke mortality in men and women: the Third National Health and Nutrition Examination Survey

PURPOSE: The aim of this study is to determine the long-term association of bone mineral density and cardiovascular disease mortality. METHODS: The data used are from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of noninstitutionalized civilians. A cohort of white, black, and Mexican-American persons ages 50 years and older at baseline (1988-1994) was followed through 2000 for coronary heart disease (CHD; n = 4690) and stroke mortality (n = 5272) using the NHANES III Linked Mortality File. RESULTS: Death certificates were used to identify 369 CHD and 166 stroke deaths. Results were evaluated to determine the relative risk of CHD or stroke per one standard deviation lower bone mineral density after adjusting for multiple risk factors. In Cox proportional hazards models, risk of CHD death and risk of stroke death were not associated with low bone mineral density among men. For women, no significant associations were found for stroke (relative risk, 1.34; 95% confidence interval, 0.86-2.07, p = 0.20) or CHD (relative risk, 1.26; 95% confidence interval, 0.88, 1.80; p = 0.21). CONCLUSIONS: Low bone mineral density was not associated with risk of cardiovascular disease in men. Among women with low bone mineral density, risk of CHD and stroke were elevated, but no significant associations were found.     

Cadmium exposure and cardiovascular disease in the 2005 Korea National Health and Nutrition Examination Survey

Background

Limited epidemiologic data are available concerning the cardiovascular effects of cadmium exposure, although recent studies suggest associations with myocardial infarction and peripheral arterial disease. We examined the associations of cadmium exposure with cardiovascular disease in nationally representative general Korean adults.

Methods

We used cross-sectional data on blood cadmium and self-reported diagnoses of ischemic heart disease (IHD), stroke, and hypertension in a sub-sample of 1908 adults, aged 20 years and older, who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). We used survey logistic regression models accounting for the complex sampling design to estimate the odds ratios (OR), adjusting for age, education, income, alcohol, smoking, body mass index, waist circumference, family history of hypertension, blood pressure, and blood lead.

Results

The geometric mean of blood cadmium was 1.53 μg/L. After adjusting for potential confounders, an interquartile range (IQR) increase in blood cadmium (0.91 μg/L) was found to be associated with an increased risk for IHD (OR 2.1, 95% confidence interval (CI) 1.3–3.4). An IQR increase in blood cadmium was found to be associated with an elevated risk for hypertension only among men (OR 1.4, 95% CI 1.1–1.8) but not among women. No association was observed with stroke in both genders.

Conclusions

These findings suggest that cadmium in blood may be associated with an increased risk for IHD and hypertension in the general Korean adult population.     

Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density

BACKGROUND: Vitamin D deficiency leads to secondary hyperparathyroidism, which has a negative effect on bone metabolism in the elderly. Puberty is an important time of bone metabolism and growth. The effect of serum 25-hydroxyvitamin D [25(OH)D] concentrations on parathyroid hormone concentrations and bone mineral density (BMD) has not been well studied cross-sectionally in adolescents. OBJECTIVE: We studied the effect of vitamin D status on serum intact parathyroid hormone (iPTH) concentrations and bone metabolism in adolescents. DESIGN: One hundred seventy-eight healthy female adolescents (aged 14-16 y) volunteered for this study, which was conducted in Finland (Helsinki, 60 degrees N) during the winter. Forearm BMD at radial and ulnar sites was measured by dual energy X-ray absorptiometry. The determinants of different variables were studied by use of regression models. RESULTS: On the basis of the relation between serum 25(OH)D and iPTH concentrations, serum 25(OH)D concentrations > approximately 40 nmol/L were needed to keep serum iPTH concentrations low. One hundred ten subjects (61.8%) had serum 25(OH)D concentrations < or =40 nmol/L. Twenty-four subjects (13.5%) were considered vitamin D deficient when the serum 25(OH)D concentration of 25 nmol/L was used as a cutoff. Subjects with serum 25(OH)D concentrations < or =40 nmol/L had low mean forearm BMD values at both the radial (P = 0.04) and ulnar (P = 0.08) sites. CONCLUSION: A large percentage of adolescent females have low vitamin D status during the winter in Finland, which seems to have negative effects on bone health.     

Acculturation in the United States is associated with lower serum carotenoid levels: Third National Health and Nutrition Examination Survey

This study examined the association of acculturation in the United States and serum carotenoid levels. The design was a cross-sectional, nationally representative survey of 16,539 participants, 17 years of age and older, from the Third National Health and Nutrition Examination Survey (NHANES III). The main outcome measures were serum levels of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, and total carotenoids. Multivariate linear regression was used to model the association of serum carotenoids and country of birth, language of interview, and years in the United States. Adjustments were made for age, sex, years of education, race/ethnicity, body mass index, alcohol use, physical activity, serum cotinine, serum cholesterol, and vitamin/mineral usage. Individuals born in the United States who speak English had the lowest levels of carotenoids, and individuals born in Mexico had the highest levels of carotenoids, with the exception of lycopene. Years of residence in the United States was associated with lower alpha-carotene (4.18 vs 1.51), beta-carotene (20.21 vs 14.87), beta-cryptoxanthin (12.51 vs 8.95), lutein/zeaxanthin (25.15 vs 18.03), and total carotenoids (88.79 vs 75.44). Years residence in the United States was positively associated with higher lycopene levels (26.69 vs 32.03). Acculturation in the United States was associated with lower fruit and vegetable intake, as measured by serum carotenoid levels.     

Socioeconomic status,food security,and chewing discomfort of Korean elders: results from the Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVESThe purpose of this study was to investigate the association between socioeconomic status and chewing discomfort and identify the role of food insecurity in the association''s causal pathway in a representative sample of Korean elders.MATERIALS/METHODSWe conducted cross-sectional analyses of the Korea National Health and Nutrition Examination Survey (2013–2015) data for elders aged ≥ 65 years. Socioeconomic status indicators used included household income and education level. Chewing discomfort was assessed according to the self-reported presence of chewing problems. Food security was surveyed using a questionnaire based on the US Household Food Security Survey Module.RESULTSThe odds ratios of chewing discomfort in the 1st and 2nd income quartiles were 1.55 (95% confidence interval [CI], 1.15–2.10) and 1.40 (95% CI, 1.03–1.90), respectively, compared to participants in the highest income quartile. Participants with the lowest education level were 1.89 (95% CI, 1.30–2.75) times more likely to have chewing discomfort than those without chewing discomfort. After including food security in the final model, the logistic coefficients were attenuated in the income and education quartiles.CONCLUSIONSLow socioeconomic status was associated with chewing discomfort. In addition, the results confirm that food insecurity can mediate the association between socioeconomic inequalities and chewing discomfort among the elderly.