This report compares LDL-C as calculated by the Friedewald, Martin, and Sampson equations in a nationally representative sample of adults with triglycerides <400 mg/dL across the distribution of clinical cut points for LDL-C (<70 mg/dL, 70 – <100 mg/dL, 100 – <160 mg/dL, 160 – <190 mg/dL, and ≥190 mg/dL) to assess the impact of equation choice on national estimates.

Objective:This report presents anthropometric reference data for the U.S. population age 2 years and older during August 2021-August 2023. Methods:Body measurements were obtained from 8,545 National Health and Nutrition Examination Survey (NHANES) participants age 2 years and older during August 2021-August 2023. Measurements included weight, height, circumferences, and limb lengths. Results:Weighted population means, standard errors of the means, and selected percentiles of body measurement values are reported for participants age 2 years and older. Body measurement results are shown by sex and age. Conclusions:These nationally representative NHANES data show the distribution of measured weight, height, body mass index, circumferences, and lengths in the U.S. population during August 2021-August 2023.

Background:Since 1972, low-density lipoprotein cholesterol (LDL-C) has been calculated by the Friedewald equation, which estimates very low-density lipoprotein cholesterol as triglycerides divided by 5 and is accurate only for triglycerides <400 mg/dL. The Martin equation, published in 2013 (for triglycerides <400 mg/dL), replaced 5 with a factor varying over an array of non-high-density lipoprotein cholesterol and triglyceride levels. This array was extended in 2021 for triglycerides 400-<800 mg/dL. In 2020, the Sampson equation, accurate for triglycerides <800 mg/dL, was developed using multiple least squares regression. This report compares LDL-C as calculated by the Friedewald, Martin, and Sampson equations in a nationally representative sample of adults with triglycerides <400 mg/dL across the distribution of clinical cut points for LDL-C (<70 mg/dL, 70-<100 mg/dL, 100-<160 mg/dL, 160-<190 mg/dL, and ≥190 mg/dL) to assess the impact of equation choice on national estimates. Methods:Using data on 4,461 adults in the 2015-2018 National Health and Nutrition Examination Survey, classification agreement into the LDL-C categories used for clinical management across the three equations was assessed using kappa statistics for men and women overall and by demographic subgroups. A sensitivity analysis assessed classification agreement between the Martin and Sampson equations for adults with triglycerides <800 mg/dL. Results:During 2015-2018, 9.8%-10.0% of adults age 20 and older had LDL-C levels <70 mg/dL (Friedewald: 10.0%, Martin: 9.8%, Sampson: 9.8%). Less than 3% had LDL-C >190 mg/dL (Friedewald: 2.3%, Martin: 2.4%, Sampson: 2.6%). Very good agreement between the equations was seen in all subgroups (kappa >0.8). Conclusions:The three equations for LDL-C produce similar U.S. population-level percent distributions for adults age 20 and older across LDL-C categories.

Introduction:This report presents the latest findings from the National Health and Nutrition Examination Survey on the prevalence, awareness, treatment, and control of hypertension among adults in the United States during August 2021-August 2023. Methods:Nationally weighted prevalence estimates of hypertension (systolic blood pressure of 130 mm Hg or above or diastolic blood pressure of 80 mm Hg or above, or self-report of current blood pressure medication use), self-reported awareness, self-reported treatment, and control (blood pressure less than 130/80 mm Hg) were obtained using National Health and Nutrition Examination Survey August 2021-August 2023 data. Variance estimates accounted for the complex survey design by using Taylor series linearization. Differences between estimates overall, among subgroups, and compared with 2017-March 2020 were tested using a t statistic at the p < 0.05 significance level. Key findings:During August 2021-August 2023, the prevalence of hypertension in adults was 47.7%, was higher in men (50.8%) than women (44.6%), and increased with age: 23.4% for ages 18-39, 52.5% for 40-59, and 71.6% for 60 and older. Among adults with hypertension, 59.2% were aware of their hypertension status, more than one-half were currently taking medication to lower blood pressure, and about one-fifth had their blood pressure controlled to less than 130/80 mm Hg. No significant change in awareness, treatment, or control of hypertension was seen among adults with hypertension between 2017-March 2020 and August 2021-August 2023.

This report provides health data from the National Center for Health Statistics.

IntroductionThe risk of diabetes begins at a lower body mass index (BMI) among Asian adults. This study compares the prevalence of diabetes in the United States and China by BMI.MethodsData from the 2015-2017 China Nutrition and Health Surveillance (n=176,223) and the 2015-2018 US National Health and Nutrition Examination Survey (n=4,464) were used. Diagnosed diabetes was self-reported. Undiagnosed diabetes was no report of diagnosed diabetes and fasting plasma glucose >=126 mg/dL or hemoglobin A1c>=6.5%. Predicted age-adjusted prevalence estimates by BMI were produced using sex- and country-specific logistic regression models.ResultsIn China, the age-adjusted prevalence of total diabetes was 7.8% (95% CI 7.4-8.3%), lower than the 14.6% (95% CI 13.1-16.3%) in the US. The prevalence of diagnosed diabetes was also lower in China than the US. There were no statistically significant differences in the prevalence of undiagnosed diabetes between China and the US. The distribution of BMI in China is lower than in the US and the predicted prevalence of total diabetes is similar in China and the US when comparing adults with the same BMI. The predicted prevalence of undiagnosed diabetes was higher in China than in the US for both men and women and this disparity increased with BMI. When comparing adults at the same BMI there was little difference in prevalence of total diabetes, but diagnosed diabetes was lower in China than the US and undiagnosed was higher.ConclusionWhile differences in BMI appear to explain nearly all of the differences in total diabetes prevalence in the two countries, not all factors that are associated with diabetes risk have been investigated.

Introduction:This report presents prevalence of high total cholesterol and low high-density lipoprotein cholesterol (HDL-C) by sex and age group for adults age 20 and older from the August 2021-August 2023 National Health and Nutrition Examination Survey (NHANES). Trends in the prevalence of high total cholesterol and low HDL-C are also presented. Methods:Data from the August 2021-August 2023 NHANES were used to estimate the prevalence of high total cholesterol (240 mg/dL or higher) and low HDL-C (less than 40 mg/dL). NHANES's complex, multistage probability sample is representative of the U.S. civilian noninstitutionalized population. The prevalence of high total cholesterol and low HDL-C were calculated using survey weights. Standard errors were estimated using Taylor series linearization, a method that accounts for the complex sample design. Differences between groups were tested using a t statistic at the p < 0.05 significance level. Linear trends for subgroups were tested using orthogonal contrast matrices, and linear and nonlinear trends over time were tested using JoinPoint software and linear regression, accounting for unequal duration and spacing of survey cycles. Key findings:During August 2021-August 2023, the prevalence of high total cholesterol was 11.3% in adults, with no significant difference between men and women overall. The prevalence of high total cholesterol was higher in adults ages 40-59 (16.7%) than in adults ages 20-39 (6.0%) and 60 and older (11.3%). The prevalence was lower in adults ages 20-39 compared with adults 60 and older. The pattern by age was different in men than in women. The prevalence of low HDL-C in adults was 13.8%, was higher in men (21.5%) than in women (6.6%) overall, and declined with increasing age for both men and women. High total cholesterol prevalence declined from 1999-2000 to 2013-2014 and remained stable through August 2021-August 2023. Low HDL-C prevalence declined from 2007-2008 to August 2021-August 2023.

This report provides health data from the National Center for Health Statistics.

Introduction: Little is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period.Methods: A longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an addi-tional six assessed at each postpartum data collection point.Results: 2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % post-partum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth.Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and grad-ually decreased thereafter.Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum.Conclusion: Reports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.

PROBLEM:A worldwide increase of caesarean section (CS) rates has been estimated at a rate of 4% per year and numerous interventions to reduce the rates have not been successful, perhaps because they are not acceptable to clinicians.BACKGROUND:A caesarean section (CS) can be a life-saving operation, but has been associated with short- and long-term risk factors and shown to affect subsequent pregnancies.AIM:To explore midwives' views on CS rates and evaluate the feasibility and acceptability of an evidence-based intervention programme (REDUCE) designed to decrease overall CS rates in Ireland by 7%.METHODS:Following ethical approval, a qualitative exploratory design was used to seek midwives' views of the evidence-based intervention. A total of 28 midwives from one large tertiary maternity hospital took part in four focus group interviews. Data were analysed using thematic analysis.FINDINGS:Five themes emerged, illustrating the midwives' views of what could be improved in the present system and how CS rates could be reduced in future. The themes included: (i) Induction of labour; (ii) Education; (iii) Auditing of practice; (iv) Clinical practice; (v) Midwife-Obstetrician collaboration.DISCUSSION:This study noted a rising CS rate year on year, with a rate of 37% at the time of the study, and the midwives voiced their very real concerns over the increased high rates.CONCLUSION:The study provided support for the evidence based 'REDUCE' intervention, which now needs to be tested empirically within this Irish population.

BACKGROUND:Caesarean section rates continue to rise in most parts of the world. While CS is a lifesaving procedure there is evidence that, beyond a certain threshold, CS rates may contribute to increased maternal and perinatal morbidity. This study aimed to elicit the views of pregnant women's and clinicians' on how CS rates might be reduced.METHODS:Pregnant women and their partners, and clinicians working with pregnant women in a maternity hospital in the Republic of Ireland of Ireland, were invited to participate in focus groups. Eligibility criteria included all women attending antenatal classes and clinicians working with pregnant women. A convenience sample was used and interviews were audio recorded, transcribed, and analysed using thematic analysis.RESULTS:Four focus group interviews were conducted with 30 clinicians and 15 pregnant women and two partners participated in three focus groups. A further two women were interviewed individually. Participants expressed a view that rising CS rates were impacted by a societal perception that CS had become a 'normal mode of birth'. Suggestions for reducing CS rates were offered by clinicians and pregnant women and their partners.CONCLUSIONS:Clinicians and pregnant women consider that CS rates can be reduced if a shared philosophy supporting normal birth is prioritised alongside adequate resourcing. Women and their partners also believe that enhanced communication with clinicians is central to reducing CS rates.

Purpose The international perinatal literature focuses on depression in the postpartum period. Prevalence and pathways of depression, anxiety and stress from pregnancy through the first postpartum year are seldom investigated. Methods MAMMI is a prospective cohort study of 3009 first-time mothers recruited in pregnancy. Depressive, anxiety and stress symptoms measured using the Depression, Anxiety and Stress Scale (DASS 21) in pregnancy and at 3-, 6-, 9- and/or 12-months postpartum. Results Prevalence of depressive and stress symptoms was lowest in pregnancy, increasing to 12-months postpartum. Anxiety symptoms remained relatively stable over time. In the first year after having their first baby, one in ten women reported moderate/severe anxiety symptoms (9.5%), 14.2% reported depression symptoms, and one in five stress symptoms (19.2%). Sociodemographic factors associated with increased odds of postpartum depression, anxiety and stress symptoms were younger age and being born in a non-EU country; socioeconomic factors were not living with a partner, not having postgraduate education and being unemployed during pregnancy. Retrospective reporting of poor mental health in the year prior to pregnancy and symptoms during pregnancy were strongly associated with poor postpartum mental health. Conclusions The current findings suggest that the current model of 6-week postpartum care in Ireland is insufficient to detect and provide adequate support for women's mental health needs, with long-term implications for women and children.

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

Eosinophilic esophagitis (EoE) is a multifactorial, complex allergic disorder of the esophagus. GWAS have identified potential causal loci, however overall these are associated with modest increases in disease risk. This study integrates gene expression and epigenetic data with GWAS to more completely characterize the molecular basis of EoE. 936 subjects with EoE of European ancestry and 4312 matched population controls were assessed using data from previously published GWAS. Single nucleotide polymorphisms (SNPs) with p<0.05 were analyzed using i-GSEA-4GWAS to uncover potential polygenic effects contributing to disease susceptibility. SNP were mapped to gene loci and compared to esophageal and air-liquid interface mRNA and protein expression data. Analysis of GWAS SNP data implicates several common pathways, including cell-cell adhesion as top enriched pathway. EoE SNPs have high degree of overlap with transcripts highly expressed in primary esophageal cells (OR: 58.7 [44.3, 77.9]) and esophageal-specific proteins (OR: 172.2 [113.7, 258.6], fisher's exact test, p<0.001). Further, comparison of EoE SNP with gene expression of IL-13-treated esophageal air liquid interface results in 696 differentially expressed transcripts at loci with EoE SNP. We observe a high degree of overlap in epithelial cell-specific transcripts and proteins in SNPs from EoE GWAS. These results shed light on the complex mechanisms underlying EoE and highlight potential target disease pathways.

GABA (γ-aminobutyric acid) is a major inhibitory neurotransmitter in molluscs and other animals, but it has not been well studied in bivalves. In humans impairment of GABA neurotransmission can cause epilepsy. In the bivalve mollusc Crassostrea virginica, as well as many other bivalves, serotonin is an excitatory neurotransmitter that increases the beating rate of gill lateral cell cilia. This serotonin innervation originates in the cerebral and visceral ganglia of the animals. Previous physiology work of our lab demonstrated that in C. virginica the action of serotonin on accelerating the beating rates of gill lateral cell cilia is blocked by applying GABA to the visceral or cerebral ganglia. Additionally, the GABAa receptor antagonist bicuculline methchloride blocked the inhibitory effect of GABA. By using HPLC we previously had detected GABA in low ng amounts in the cerebral and visceral ganglia of C. virginica. Our earlier immunofluorescence histochemistry studies also showed the presence of GABA neurons in both the cerebral and visceral ganglia; and that some serotonin neurons in the ganglia had GABA receptors on their soma. Recently the genome of C. virginica and other bivalves have begun to be mapped. We hypothesize that C. virginica contains genes for GABA receptors and that these receptors are similar to those found in other animals, including mammals and humans. To study this we conducted BLAST searches of the NCBI (National Center for Biotechnology Information) database using the DNA and protein sequences from C. virginica and other invertebrate and mammalian species GABAa and GABAb receptor genes. We found matches for GABAa and GABAb receptor genes located on C. virginica chromosomes 3 and 5, respectively. Doing BLASTS of the receptors of other invertebrates and mammals found matches with very low Expect Values (E values) and high Percent Identity, signifying high similarities of the GABAa and GABAb receptors of C. virginica to those in other bivalves, gastropods, insects mice, rats and humans. Various invertebrates had Percent Identity above 60%, while humans and mice had Percent Identity of about 40% for GABAa and 50% for GABAb. This study complements our earlier physiology and cell biology studies demonstrating the presence and a function for GABA in C. virginica, and shows that the genome of C. virginica contains genes to produce GABA receptors that are similar to those found in other animals. This new information is valuable as it shows that the simple nervous system of C. virginica can be used to conduct studies on GABA neurotransmission.

Manganese (Mn) is an essential metal but toxic exposure causes accumulation in human brain and extrapyramidal symptoms called manganism, which is clinically similar to Parkinson's disease. Mn disrupts dopamine (DA) neurotransmission. The neurotoxic mechanism of Mn is not fully understood. Currently there are no effective treatments. Proposed mechanisms of Mn toxicity include elevated oxidative stress and mitochondrial (MITO) dysfunction. Using the Eastern Oyster, Crassostrea virginica, as a model to study Mn toxicity on the animal and its DA system, we previously showed Mn interferes with DA's cilio-inhibitory effect in oyster gill cells, and reduces gill MITO O2 consumption and MITO membrane potential. We also showed the toxic effects were reduced or prevented by p-aminosalicylic acid (PAS), taurine (TAU) and carnosine (CAR). We hypothesize PAS, TAU and CAR are protective against Mn induced MITO dysfunction in other animals including mammals. To study this we analyzed published data of other labs to qualify and quantify the MITO dysfunction reported in animals exposed to toxic levels of Mn and determine if PAS, TAU or CAR were effective in alleviating the damage. We found in invertebrates and vertebrates, including mice and rats, Mn caused MITO dysfunction. The damage included: inhibition of MITO electron transport chain, decreased O2 consumption, oxidative phosphorylation interference of ATP synthase, decreased MITO dehydrogenases and glutathione peroxidase, decreased MITO membrane potential, altered MITO permeability and disruption of MITO Ca2+ homeostasis with resulting MITO swelling. While less data was available on the use of PAS, TAU and CAR against Mn induced MITO dysfunction, there were significant number of reports these agents showed various degrees of efficacy against Mn toxicity in other animals. PAS, which generally is thought to work by chelating Mn, was reported to reduce neuro-inflammation, oxidative stress and intracellular reactive O2 species (ROS) generation. It also prevented Mn induced loss of MITO membrane potential and reduced O2 consumption. TAU preserved MITO ATP as well as membrane potential, prevented swelling and increased MITO dehydrogenases activity. CAR was reported to regulate MITO matrix pH, preserve membrane potential, increase respiratory chain complexes activity and enhance MITO energy production. These findings concur with our previous work on Mn toxicity in oyster mitochondria, and support our hypothesis PAS, TAU and CAR show protective actions against Mn induced MITO dysfunction in other animals. They further support our use of C. virginica as a model animal to study the mechanisms underlying Mn toxicity and generate new information to assist in the design of future experiments, the results of which should be of interest to those exploring possible agents in the prevention or therapeutic treatment of manganism.

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

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

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

While most women remain healthy after giving birth to their baby, others experience complications that require medical attention or readmission to hospital. However, data on maternal attendance for medical care postpartum or readmission to hospital are not collected or reported routinely in many countries so the extent of health problems experienced remain unknown. Collecting data on the proportion of women who seek medical care in the early postpartum period may deepen understanding of risk factors, the consequences for women, their families and the maternity care system and, ultimately, help identify preventative strategies and processes. Objective To identify the factors associated with maternal rehospitalisation, attendance at emergency rooms or visits to general practitioners, the three main sources of medical services postpartum in Ireland, within the first three months postpartum. Study Design A prospective cohort study, embedded in a larger maternal health and morbidity study, with 1668 nulliparous women recruited from two maternity hospitals in Ireland. Univariate and multivariable logistic regression analyses were used to explore associations with postpartum rehospitalisation, emergency room attendance and general practitioner visits within the first three months postpartum, for maternal health-related reasons. Results Four percent (n = 66) of women were rehospitalised, 10% (n = 166) attended an emergency room, and 13.6% (n = 223) attended their general practitioner three or more times, regarding their own health. Women aged 24 years or less were more likely to attend their doctor (p = 0.02, AOR 2.13, 95% CI 1.08-4.21) compared to women aged 25-29 years, the reference category. Women who were obese or very obese were also more likely to attend their doctor three or more times (p = 0.01, AOR 1.79, 95% CI 1.15-2.79) and also more likely to attend an emergency room (p = 0.04, AOR 1.69, 95% CI 1.02-2.80) within three months postpartum, for their own health reasons. Conclusion Findings indicate that considerable proportions of women seek medical care from various healthcare sources postpartum. These medical visits are not routinely reported and point to the need for interventions regarding the care, management and services available to first-time mothers birthing in Ireland, with specific attention on preventative postpartum health.