Inflammation is known to affect many biomarkers used in the assessment of micronutrient status. The prevalence of inflammation as measured by C‐reactive protein (CRP, >5 mg/L) and alpha1‐acid glycoprotein (AGP, >1 mg/L) and individual‐level factors associated with these markers have not been characterized across a variety of environments. Using data from 12 Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia (BRINDA) household‐based survey datasets, survey design‐adjusted prevalence estimates of inflammation among preschool children were calculated. Prevalence estimates were compared overall and by sex, age (6‐11mo, 12‐23, 24‐35, 36‐59, association measure if >2 groups included), socioeconomic status (SES, asset index quintile), stunting (<‐2 height‐for‐age z score) and wasting (<‐2 weight‐for‐height z score) (chi square, p<0.05). Prevalence of elevated CRP and AGP ranged from 6.0 (USA) to 40.2% (Cote D'Ivoire) and 20.8 (Philippines) to 64.3% (Cote D'Ivoire), respectively. Sex was associated with inflammation in Laos. Age was inconsistently not (n=5), negatively (n=3, with AGP only), and positively (n=2) associated with inflammation. Inflammation was inversely associated with SES in 6 of 8 countries with relevant data. In a majority of countries AGP was positively associated with stunting (n=7) and wasting (n=5). While there is a strong negative association across countries between inflammation and both growth and SES in preschool children, age and sex showed inconsistent relationships. There is a need to better understand factors influencing the risk of inflammation in various settings.

P-205 Introduction: We examined vitamin/supplement (V/S) use and its association with sociodemographic, health behavior and health conditions among non-institutionalized adults in 13 states. Methods: We used data from a cross-sectional study of noninstitutionalized adults aged 18 or older in 13 states that participated in the Behavioral Risk Factor Surveillance System in 2001 to stratify respondents by sociodemographics, health risk behaviors, and health conditions in relationship to vitamin or supplement use. Results: Of 45,415 eligible participants, 56.5% (n=5,652) reported current use of V/S. After adjusting for age, gender, race/ethnicity and education, we found statistically significant association between V/S use and positive health behavior (AOR=1.46, P<0.001). We found no association between V/S use and the absence of specific chronic conditions. Also, V/S use increased with age (P<0.001). Conclusion: People who use vitamins or supplements in the states surveyed are more likely to demonstrate health behaviors. Therefore, individuals who are most likely to use V/S are least likely to need them. It is crucial that individuals report quantity and frequency of supplement when providing diet histories.

BACKGROUND:During the past 20 years, adult obesity rates have doubled in the United States. The National Institutes of Health (NIH) issued guidelines in 1998 recommending that healthcare professionals advise obese patients to lose weight. We examined trends in physician counseling for weight loss during 1994-2000, characteristics of obese adults receiving advice to lose weight in 2000, and the association in 2000 between receiving advice and attempting to lose weight.METHODS:We analyzed 1994, 1996, 1998, and 2000 data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of noninstitutionalized adults from 48 states and the District of Columbia. We limited the analysis to obese respondents who had visited physicians for a routine medical checkup during the previous 12 months (n = 61,968).RESULTS:Among obese patients, the proportion who received advice to lose weight decreased from 42.3% (se = 0.79) in 1994 to 40.3% (se = 0.55) in 2000. We observed declines in receipt of advice for almost all subgroups. Respondents in the youngest and oldest age groups and those without health insurance had the largest significant declines. Patients who reported receiving advice to lose weight had 2.8 the odds of trying to lose weight as those who did not receive advice (95% confidence interval, 2.5, 3.2).CONCLUSION:Despite the 1998 NIH guidelines and increases in morbid obesity, the proportion of obese persons who reported being counseled by a healthcare professional has declined slightly. Because counseling might be associated with weight loss attempts, barriers to counseling need to be identified and addressed.

OBJECTIVE:To describe the trends, costs, and complications associated with weight loss surgery (WLS).RESEARCH METHODS AND PROCEDURES:Wisconsin inpatient hospital discharge data from 1990 to 2003 were used for analysis. A WLS case was defined as anyone with a WLS-related procedure code and a primary diagnosis of morbid obesity. Charges were inflation-adjusted to 2001 constant dollars; complications were defined on the basis of readmission, extended length of stay, repeat surgical procedures, or death.RESULTS:The number of WLSs increased from 269 in 1990 to 1992 to 1,884 in 2000 to 2002 (rate ratio = 4.6). Increases in WLSs were greatest among those 50 to 59 years of age (rate ratio = 6.4), women (rate ratio = 6.8), and blacks (rate ratio = 20.0). Between the two periods, inflation-adjusted WLS charges increased 12-fold, and the inflation-adjusted charge per procedure doubled, despite a decreased length of stay. For 2000 to 2002, 23.3% of WLS patients had either an extended length of stay or readmission within 30 days, 7.4% required a repeat surgical procedure, and 0.7% died.DISCUSSION:In Wisconsin, the rate and costs of WLSs have increased dramatically, and the incidence of postoperative complications was high. The epidemic of obesity in the United States makes it imperative to better assess the cost-effectiveness of WLS and to improve its safety.

Objective: To determine whether low fat intake is associated with increased risk of nutritional inadequacy in children 2 to 8 years old and to identify eating patterns associated with differences in fat intake.Study design: Using 2 days of recall from the Continuing Survey of Food Intake by Individuals (CSFII), 1994 to 1996, we classified 2802 children into quartiles of energy intake from fat (<29%, 29% to 31.9% [defined as moderate fat], 32% to 34.9%, and greater than or equal to 35%) and compared nutrient intakes, the proportion of children at risk for inadequate intakes, Food Pyramid servings, and fat content per serving across quartiles.Results: here children in quartile 2 were at risk for inadequate intakes of vitamin E, calcium, and zinc than children in higher quartiles (P < .0001); more children in quartiles 3 and 4 were at risk for inadequate intakes of vitamins A and C and folate (P < .001). Fruit intake decreased across quartiles (P < .0001); whereas vegetable, meat, and fat-based condiment intakes increased (P < .0001). Fat per serving of grain, vegetables, dairy, and meat increased across quartiles (P < .0001).Conclusions: Moderate-fat diets were not consistently associated with an increased proportion of children at risk for nutritional inadequacy, and higher-fat diets were not consistently protective against inadequacy. Dietary fat-could be reduced by judicious selection of lower-fat foods without compromising nutritional adequacy.

OBJECTIVES:This study examined trends in fruit and vegetable consumption among adults in 16 US states.METHODS:Data from telephone surveys were used to stratify respondents by sociodemographic and health-related characteristics.RESULTS:The proportion of adults who consumed fruits and vegetables at least 5 times daily was 19%, 22%, and 23% in 1990, 1994, and 1996, respectively. While the proportion increased among those with active leisure-time physical activities and normal weight, it remained almost the same among inactive people and dropped among the obese.CONCLUSIONS:Progress in fruit and vegetable intake from 1990 to 1994 was encouraging, but it changed little between 1994 and 1996.

OBJECTIVES: This study compared trends in body mass index for American Indian men and women across selected regions of the United States. METHODS: Self-reported data were collected from the Behavioral Risk Factor Surveillance System. RESULTS: Among women in the Dakotas, New Mexico and Arizona, and Washington and Oregon, average adjusted body mass index increased significantly by 0.1 to 0.2 units per year. Among men in Alaska and the Dakotas, average adjusted body mass index also increased significantly by 0.1 to 0.2 units each year. CONCLUSIONS: Because of rapid increases in average body mass index, some American Indian populations could be burdened by an increased incidence of chronic disease.

OBJECTIVE: This study compared fruit and vegetable assessments derived from 4 self-administered questionnaires. METHODS: Among 102 adolescents, servings of fruits and vegetables assessed by 4 questionnaires were compared with estimates from 24-hour recalls. RESULTS: The prevalence of consuming 5 or more servings of fruits and vegetables a day was underestimated by the questionnaires. Questionnaires asking subjects to recall their diet over the previous year were more effective in ranking subjects (r's > or = .42) than those assessing previous-day diet (r's > or = .30). CONCLUSIONS: Brief assessments of fruit and vegetable intake are more useful for ranking subjects than for estimating prevalence of consumption of 5 or more servings per day.

Information about dietary behaviors, attitudes, and knowledge is important for state and local health agencies because national monitoring lacks the local representativeness and timeliness necessary to catalyze community interest and to design, target, and evaluate dietary intervention programs. Currently, however, both methods and resources are limited for surveying diet in the population of a state or community. Brief assessments are included in the Youth Risk Behavior Surveillance System for adolescents, which is conducted by state departments of education, and in the Behavioral Risk Factor Surveillance System for adults, which is operated by state departments of health. More quantitatively precise measurements are being made by a few stales and communities but personnel and financial resources for such surveys are limited. Nutritionists in state and local health agencies should explore the possibility of developing public-private partnerships with food producers, retailers, and marketers to collect information about dietary determinants and behaviors in states and communities. Better standardization of dietary assessment methods is needed, asis development of better methods to identify attitudes about diet and barriers to dietary improvement. Most important, though, dietary surveillance in stales and communities must be more strongly tied to intervention programs intended to improve nutrition in those populations.

OBJECTIVE To estimate how frequently adults in the United States drive while impaired by alcohol. DESIGN Telephone survey. SETTING The 49 states (and the District of Columbia) that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 1993. PARTICIPANTS A total of 102,263 noninstitutionalized adults aged 18 years or older. MAIN OUTCOME MEASURES The percentage of respondents who reported alcohol-impaired driving; number of episodes of alcohol-impaired driving per 1000 adult population; and total number of episodes of alcohol-impaired driving-each by age, sex, race, level of education, and state. RESULTS Overall, 2.5% of adults reported an estimated 123 million episodes of alcohol-impaired driving in 1993. This corresponds to 655 episodes of alcohol-impaired driving for each 1000 adults (range among states per 1000 adults, 165-1550). Alcohol-impaired driving was most frequent among men aged 21 to 34 years (1739 episodes per 1000 adults) and was nearly as frequent among men aged 18 to 20 years (1623 episodes per 1000 adults), despite legislation in all states that prohibited the sale of alcohol to persons younger than age 21 years in 1993. CONCLUSIONS Alcohol-impaired driving is common even among underage persons. Strict enforcement of laws that discourage alcohol-impaired driving is needed along with community and patient education to reduce the prevalence of alcohol-impaired driving and prevent injuries and deaths from alcohol-related motor vehicle crashes. Data from the BRFSS, an ongoing source of national and state-specific data on the number of episodes of alcohol-impaired driving, are potentially useful for monitoring trends and evaluating the effect of future efforts to reduce alcohol-impaired driving.

Objectives. Using data from the Behavioral Risk Factor Surveillance System, this study describes trends in the prevalence of overweight between 1987 and 1993.Methods. Data were examined from 33 states participating in an ongoing telephone survey of health behaviors of adults (n = 387 704); Self-reported weights and heights were used to calculate sex-specific prevalence estimates of overweight for each year from 1987 to 1993. Time trends were evaluated with the use of linear regression.Results. Between 1987 and 1993, the age-adjusted prevalence of overweight increased by 0.9% per year for both sexes (from 21.9% to 26.7% among men and from 20.6% to 25.4% among women). The increasing linear trend was observed in all subgroups of the population but was most notable for Black men (1.5% per year) and men living in-the Northeast (1.4% per year). Secular changes in smoking and leisure-time, physical activity did not entirely account for the increase in overweight.Conclusions. The prevalence of overweight among American adults increased by 5% between 1987 and 1993. Efforts are needed to explore the causes of this adverse trend and to find effective strategies to prevent obesity.