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.

This chapter presents the demographic and socioeconomic characteristics of people with and without diabetes. The main data source is the National Health Interview Survey (NHIS), with supplemental information from the National Health and Nutrition Examination Survey (NHANES). Estimates from these surveys are nationally representative of the U.S. civilian noninstitutionalized population and are presented for adults age ≥20 years with diabetes diagnosed at either age 7% of adults with diabetes received Supplemental Security Income usually due to a disability compared to 2.2% of adults without diabetes.

Diabetes is a major cause of morbidity and mortality in the United States (1-3). Diabetes can be present but undiagnosed, meaning that a person can have diabetes but not report having ever been told by a doctor or health professional that they have the condition. Type 2 diabetes can progress over an extended time period with gradual, often unnoticed, changes occurring before diagnosis. If left unmanaged, diabetes may contribute to serious health outcomes including neuropathy, nephropathy, retinopathy, coronary artery disease, stroke, and peripheral vascular disease (4). This report presents the prevalence of total, diagnosed, and undiagnosed diabetes in U.S. adults in 2013-2016.

To the Editor: The prevalence of anemia is known to increase with age and is associated with negative health outcomes, including greater risk of hospitalizations and greater mortality. Anemia in older adults can be due to nutrient deficiencies, chronic kidney disease, chronic inflammation, or inflammatory disease or can be unexplained. Because of the potential health consequences and potentially changing prevalence of underlying causes, it is important to have updated national anemia estimates and trends over time for this population.

Diabetes in America, 3rd Edition, is a compilation and assessment of epidemiologic, public health, clinical, and clinical trial data on diabetes and its complications in the United States. It was published by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, during 2016–2018. The intended audience is the wide range of individuals in the research community, clinicians, health policy makers, and individuals with diabetes, as well as their caregivers and family members.Diabetes in America, 3rd Edition, contains 42 chapters organized into three areas: Section I: Spectrum of Diabetes: Descriptive epidemiology of diabetes in the United States based on national surveys and community-based studies, including prevalence and incidence; sociodemographic, metabolic, and lifestyle characteristics; genetics and risk factors for developing diabetes; and unique aspects of diabetes in younger and older populations, and in pregnant women (chapters 1–16) Section II: Complications of Diabetes and Related Conditions: The myriad complications that affect patients with diabetes, including mortality (chapters 17–36) Section III: Prevention and Medical Care for Diabetes: Clinical trials and studies to prevent diabetes; medication use and self-care practices, health care utilization, and quality of care; and economic aspects including health insurance and health care costs (chapters 37–42)

Aims: To determine (1) the prevalence of SubD states among adults with diabetes, and (2) whether evidence exists of an independent association between diabetes status and SubD, controlling for selected confounders.Methods: Data from the 2007-2012 National Health and Nutrition Examination Surveys were combined to estimates of depressive states by diabetes status among the noninstitutionalized U.S. adult population, and to assess the association of diabetes status and depressive states using a polytomous logistic regression model.Results: An estimated 17%, or 3.7 million, of U.S. adults with diabetes (diagnosed and undiagnosed) met criteria for either mD or ssD. The majority of SubD cases with diabetes were found to be ssD (10.1%) compared with mD (6.9%). After controlling for the effects of age, sex, race and ethnicity, education, body mass index, and poverty as covariates, an independent association persists between diagnosed diabetes and each SubD grouping (ssD: OR = 1.82, CIs 1.33, 2.47; mD: OR = 1.95, CIs 1.39, 2.74) compared with respondents having no diabetes. No association was found between depression and undiagnosed diabetes or prediabetes compared with those having no diabetes.Conclusion: Milder forms of depression such as ssD and mD are more extant than major depressive episodes among adults with diabetes. The odds that an adult with diagnosed diabetes meets the criteria for ssD or mD are higher by 80% and 95%, respectively, after controlling for age, sex, race and ethnicity, education, body mass index, and poverty factors when compared against adults with no diabetes. Published by Elsevier Ireland Ltd.

Background:Trends in the prevalence of chronic kidney disease (CKD) are important for health care policy and planning.Objective:To update trends in CKD prevalence.Design:Repeated cross-sectional study.Setting:NHANES (National Health and Nutrition Examination Survey) for 1988 to 1994 and every 2 years from 1999 to 2012.Participants:Adults aged 20 years or older.Measurements:Chronic kidney disease (stages 3 and 4) was defined as an estimated glomerular filtration rate (eGFR) of 15 to 59 mL/min/1.73 m2, estimated with the Chronic Kidney Disease Epidemiology Collaboration equation from calibrated serum creatinine measurements. An expanded definition of CKD also included persons with an eGFR of at least 60 mL/min/1.73 m2 and a 1-time urine albumin-creatinine ratio of at least 30 mg/g.Results:The unadjusted prevalence of stage 3 and 4 CKD increased from the late 1990s to the early 2000s. Since 2003 to 2004, however, the overall prevalence has largely stabilized (for example, 6.9% prevalence in 2003 to 2004 and in 2011 to 2012). There was little difference in adjusted prevalence of stage 3 and 4 CKD overall in 2003 to 2004 versus 2011 to 2012 after age, sex, race/ethnicity, and diabetes mellitus status were controlled for (P = 0.26). Lack of increase in CKD prevalence since the early 2000s was observed in most subgroups and with an expanded definition of CKD that included persons with higher eGFRs and albuminuria.Limitation:Serum creatinine and albuminuria were measured only once in each person.Conclusion:In a reversal of prior trends, there has been no appreciable increase in the prevalence of stage 3 and 4 CKD in the U.S. population overall during the most recent decade.Primary Funding Source:American Society of Nephrology Foundation for Kidney Research Student Scholar Grant Program, Centers for Disease Control and Prevention, and National Institutes of Health.

Objective: We examined the diabetes-fracture relationship by race/ethnicity, including the link between prediabetes and fracture.Research design and methods: We used Medicare- and mortality-linked data for respondents aged 65 years and older from the third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2004 for three race/ethnic groups: non-Hispanic whites (NEW), non-Hispanic blacks (NHB), and Mexican Americans (MA). Diabetes was defined as diagnosed diabetes (self-reported) and diabetes status: diagnosed and undiagnosed diabetes (positive diagnosis or hemoglobin A(1c) (A1C) >= 6.5%); pre-diabetes (no diagnosis and A1C between 5.7% and 6.4%); and no diabetes (no diagnosis and A1C < 5.7%). Non-skull fractures (n = 750) were defined using published algorithms. Hazards ratios (HRs) were calculated using Cox proportional hazards models.Results: The diabetes-fracture relationship differed significantly by race/ethnicity (P-interaction < 0.05). Compared to those without diagnosed diabetes, the HRs for those with diagnosed diabetes were 2.37 (95% Cl 1.49-3.75), 1.87 (95%CI 1.02-3.40), and 122 (95% Cl 0.93-1.61) for MA, NHB, and NHW, respectively, after adjusting for significant confounders. HRs for diagnosed and undiagnosed diabetes were similar to those for diagnosed diabetes alone. Pre-diabetes was not significantly related to fracture risk, however. Compared to those without diabetes, adjusted HRs for those with pre-diabetes were 1.42 (95% Cl 0.72-2.81), and 1.20 (95% CI 0.96-1.51) for MA and NEW, respectively. There were insufficient fracture cases to examine detailed diabetes status in NHB.Conclusions: The diabetes-fracture relationship was stronger in MA and NHB. Pre-diabetes was not significantly associated with higher fracture risk, however. Published by Elsevier Inc.

Objective. We estimated the prevalence of preventive aspirin and/or other antiplatelet medication use and the dosage of aspirin use in the U.S. adult population. Methods. We conducted cross-sectional analyses of a representative sample ( n=3,599) of U.S. adults aged ≥40 years from the National Health and Nutrition Examination Survey, 2011–2012. Results. In 2011–2012, one-third of U.S. adults aged ≥40 years reported taking preventive aspirin and/or other antiplatelet medications, 97% of whom indicated preventive aspirin use. Preventive aspirin use increased with age (from 11% of those aged 40–49 years to 54% of those ≥80 years of age, p<0.001). Non-Hispanic white (35%) and black (30%) adults were more likely to take preventive aspirin than non-Hispanic Asian (20%, p<0.001) and Hispanic (22%, p=0.013) adults. Adults with, compared with those without health insurance, and adults with ≥2 doctor visits in the past year, diagnosed diabetes, hypertension, or high cholesterol were twice as likely to take preventive aspirin. Among those with cardiovascular disease, 76% reported taking preventive aspirin and/or other antiplatelet medications, of whom 91% were taking preventive aspirin. Among adults without cardiovascular disease, 28% reported taking preventive aspirin. Adherence rates to medically recommended aspirin use were 82% overall, 91% for secondary prevention, and 79% for primary prevention. Among current preventive aspirin users, 70% were taking 81 milligrams (mg) of aspirin daily and 13% were taking 325 mg of aspirin daily. Conclusion. The vast majority of antiplatelet therapy is preventive aspirin use. A health-care provider's recommendation to take preventive aspirin is an important determinant of current preventive aspirin use.

Previous estimates of the prevalence of nonalcoholic fatty liver disease (NAFLD) in the US population relied on measures of liver enzymes, potentially underestimating the burden of this disease. We used ultrasonography data from 12,454 adults who participated in the Third National Health and Nutrition Examination Survey, conducted in the United States from 1988 to 1994. We defined NAFLD as the presence of hepatic steatosis on ultrasonography in the absence of elevated alcohol consumption. In the US population, the rates of prevalence of hepatic steatosis and NAFLD were 21.4% and 19.0%, respectively, corresponding to estimates of 32.5 (95% confidence interval: 29.9, 35.0) million adults with hepatic steatosis and 28.8 (95% confidence interval: 26.6, 31.2) million adults with NAFLD nationwide. After adjustment for age, income, education, body mass index (weight (kg)/height (m)²), and diabetes status, NAFLD was more common in Mexican Americans (24.1%) compared with non-Hispanic whites (17.8%) and non-Hispanic blacks (13.5%) (P = 0.001) and in men (20.2%) compared with women (15.8%) (P < 0.001). Hepatic steatosis and NAFLD were also independently associated with diabetes, with insulin resistance among people without diabetes, with dyslipidemia, and with obesity. Our results extend previous national estimates of the prevalence of NAFLD in the US population and highlight the burden of this disease. Men, Mexican Americans, and people with diabetes and obesity are the most affected groups.

BACKGROUND & AIMS:A genome-wide association study associated 5 genetic variants with hepatic steatosis (identified by computerized tomography) in individuals of European ancestry. We investigated whether these variants were associated with measures of hepatic steatosis (HS) in non-Hispanic white (NHW), non-Hispanic black, and Mexican American (MA) participants in the US population-based National Health and Nutrition Examination Survey III, phase 2.METHODS:We analyzed data from 4804 adults (1825 NHW, 1442 non-Hispanic black, and 1537 MA; 51.7% women; mean age at examination, 42.5 y); the weighted prevalence of HS was 37.3%. We investigated whether ultrasound-measured HS, with and without increased levels of alanine aminotransferase (ALT), or level of ALT alone, was associated with rs738409 (patatin-like phospholipase domain-containing protein 3 [PNPLA3]), rs2228603 (neurocan [NCAN]), rs12137855 (lysophospholipase-like 1), rs780094 (glucokinase regulatory protein [GCKR]), and rs4240624 (protein phosphatase 1, regulatory subunit 3b [PPP1R3B]) using regression modeling in an additive genetic model, controlling for age, age-squared, sex, and alcohol consumption.RESULTS:The G allele of rs738409 (PNPLA3) and the T allele of rs780094 (GCKR) were associated with HS with a high level of ALT (odds ratio [OR], 1.36; P = .01; and OR, 1.30; P = .03, respectively). The A allele of rs4240624 (PPP1R3B) and the T allele of rs2228603 (NCAN) were associated with HS (OR, 1.28; P = .03; and OR, 1.40; P = .04, respectively). Variants of PNPLA3 and NCAN were associated with ALT level among all 3 ancestries. Some single-nucleotide polymorphisms were associated with particular races or ethnicities: variants in PNPLA3, NCAN, GCKR, and PPP1R3B were associated with NHW and variants in PNPLA3 were associated with MA. No variants were associated with NHB.CONCLUSIONS:We used data from the National Health and Nutrition Examination Survey III to validate the association between rs738409 (PNPLA3), rs780094 (GCKR), and rs4240624 (PPP1R3B) with HS, with or without increased levels of ALT, among 3 different ancestries. Some, but not all, associations between variants in NCAN, lysophospholipase-like 1, GCKR, and PPP1R3B with HS (with and without increased ALT level) were significant within subpopulations.

BACKGROUND: Albuminuria, defined as urine albumin/creatinine ratio (ACR) >= 30 mg/g, is a diagnostic component of chronic kidney disease (CKD). National estimates of ACR and CKD prevalence have been based on single random urine samples. Although 2 urine samples or a first morning void are known to produce different estimates of ACR, the impact of differing urine sampling schemes on nationally estimated rates of CKD is unknown.METHODS: In 2009-2010, the National Health and Nutrition Examination Survey (NHANES) participants provided 2 untimed urine samples for sequential ACR measurement: an initial random urine collected in the NHANES mobile examination center and a subsequent first morning void collected at home. Rates of albuminuria were calculated in the overall population and broken down by demographics, diagnosed diabetes and hypertension status, and estimated glomerular filtration rate (eGFR).RESULTS: Overall, 43.5% of adults with increased ACR (>= 30 mg/g) in a random urine also had increased ACR in a first morning urine. This percentage was higher among individuals >= 50 years old (48.9%), males (53.3%), participants with diagnosed diabetes (56.3%) and hypertension (51.5%), and eGFR <60 mL/min/1.72m(2) (56.9%). The use of confirmed increased ACR (defined as the presence of ACR >= 30 mg/g in both samples taken within 10 days) to define CKD resulted in a lower overall prevalence (11.6%) than first morning urine (12.7%) or random spot urine only (15.2%).CONCLUSIONS: ACR measured on random urine samples appears to overestimate the prevalence of albuminuria compared to first morning urine collections. (C) 2013 American Association for Clinical Chemistry

OBJECTIVE:To provide estimates of selected nutrient intakes and chronic health conditions among Mexican-American adults aged 20-74 years in the United States, from 1982 through 2006.METHODS:Data on Mexican-American adults come from the following surveys: the Hispanic Health and Nutrition Examination Survey (HHANES, 1982-1984 (n = 3,935)); the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994 (n = 4,641)); and NHANES 1999-2006 (n = 4,084). Prevalence estimates were calculated and trend analyses were conducted for each nutrient intake and health condition in the study. Statistical significance of differences between common estimates from each survey period was evaluated using two-sided t-tests (p < 0.05).RESULTS:Between 1982-1984 and 1999-2006, the percent kilocalories from total fat, saturated fat, and protein intake among Mexican-American adults decreased, while carbohydrate and mean total energy intake increased. During this same time period, the prevalence of obesity and diabetes among Mexican-American adults increased, the prevalence of dental caries decreased, and the prevalence of high blood pressure remained stable. The overall prevalence of high total serum cholesterol among this group did not differ significantly from 1988-1994 to 1999-2006.CONCLUSION:Monitoring trends in diet and health conditions among Mexican-American adults can inform the development of targeted prevention efforts to improve the health of this rapidly increasing population.