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Background: Consuming seafood has health benefits, but seafood can also contain methylmercury, a neurotoxicant. Exposure to methylmercury affects children at different stages of brain development, including during adolescence. Objective: The objective was to examine seafood consumption and blood mercury concentrations in US youth. Methods: In the 2009‐2012 NHANES, a cross-sectional nationally representative sample of the US population, seafood consumption in the past 30 d and blood mercury concentrations on the day of examination were collected from 5656 youth aged 1‐19 y. Log-linear regression was used to examine the association between frequency of specific seafood consumption and blood mercury concentration, adjusting for race/Hispanic origin, sex, and age. Results: In 2009‐2012, 62.4% 6 1.4% (percent 6 SE) of youth consumed any seafood in the preceding month; 38.4% 6 1.4% and 48.5% 6 1.5% reported consuming shellfish and fish, respectively. In 2009‐2012, the geometric mean blood mercury concentration was 0.50 6 0.02 mg/L among seafood consumers and 0.27 6 0.01 mg/L among those who did not consume seafood. Less than 0.5% of youth had blood mercury concentrations $5.8 mg/L. In adjusted log-linear regression analysis, no significant associations were observed between frequency of breaded fish or catfish consumption and blood mercury concentrations, but frequency of consuming certain seafood types had significant positive association with blood mercury concentrations: high-mercury fish (swordfish and shark) [exponentiated b coefficient (expb): 2.40; 95% CI: 1.23, 4.68]; salmon (expb: 1.41; 95% CI: 1.26, 1.55); tuna (expb: 1.38; 95% CI: 1.29, 1.45); crabs (expb: 1.35; 95% CI: 1.17, 1.55); shrimp (expb: 1.12; 95% CI: 1.05, 1.20), and all other seafood (expb: 1.23; 95% CI: 1.17, 1.32). Age-stratified loglinear regression analyses produced similar results. Conclusion: Few US youth have blood mercury concentrations $5.8 mg/L, although more than half of US youth consumed seafood in the past month. JN utrdoi: 10.3945/jn.114.203786.

Obesity is associated with serious health risks. Monitoring obesity prevalence is relevant for public health programs that focus on reducing or preventing obesity. Between 2003–2004 and 2013–2014, there were no significant changes in childhood obesity prevalence, but adults showed an increasing trend. This report provides the most recent national estimates from 2015–2016 on obesity prevalence by sex, age, and race and Hispanic origin, and overall estimates from 1999–2000 through 2015–2016.

Hypertension is an important and common risk factor for heart disease and stroke, two of the leading causes of death in adults in the United States. Despite considerable improvement in increasing the awareness, treatment, and control of hypertension, undiagnosed and uncontrolled hypertension remain public health challenges (1). Data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension, as well as awareness, treatment, and control of hypertension among adults aged ≥18 years in Los Angeles County compared with adults aged ≥18 years in the United States during 1999-2006 and 2007-2014. During 2007-2014, the prevalence of hypertension was 23.1% among adults in Los Angeles County, lower than the prevalence of 29.6% among all U.S. adults. Among adults with hypertension in Los Angeles County, substantial improvements from 1999-2006 to 2007-2014 were found in hypertension awareness (increase from 73.8% to 84.6%), treatment (61.3% to 77.2%), and control (28.5% to 48.3%). Similar improvements were also seen among all U.S. adults. Although the prevalence of hypertension among adults in Los Angeles County meets the Healthy People 2020 (https://www.healthypeople.gov/) goal of ≤26.9%, continued progress is needed to meet the Healthy People 2020 goal of ≥61.2% for control of hypertension.

Objective To examine the associations among several body mass index (BMI) metrics ( z -scores, percent of the 95th percentile (%BMI p95 ) and BMI minus 95th percentile (ΔBMI p95 ) as calculated in the growth charts from the Centers for Disease Control and Prevention (CDC). It is known that the widely used BMI z -scores (BMIz) and percentiles calculated from the growth charts can differ substantially from those that directly observed in the data for BMIs above the 97th percentile ( z = 1.88). Study design Cross-sectional analyses of 8.7 million 2- to 4-year-old children who were examined from 2008 through 2011 in the CDC's Pediatric Nutrition Surveillance System. Results Because of the transformation used to calculate z -scores, the theoretical maximum BMIz varied by >3-fold across ages. This results in the conversion of very high BMIs into a narrow range of z -scores that varied by sex and age. Among children with severe obesity, levels of BMIz were only moderately correlated (r ~ 0.5) with %BMI p95 and ΔBMI p95 . Among these children with severe obesity, BMIz levels could differ by more than 1 SD among children who had very similar levels of BMI, %BMI p95 and ΔBMI p95 due to differences in age or sex. Conclusions The effective upper limit of BMIz values calculated from the CDC growth charts, which varies by sex and age, strongly influences the calculation of z -scores for children with severe obesity. Expressing these very high BMIs relative to the CDC 95th percentile, either as a difference or percentage, would be preferable to using BMI-for-age, particularly when assessing the effectiveness of interventions.

SummaryBackground Few studies have assessed how well body mass index (BMI), waist circumference (WC), or waist to height ratio (WtHR) perform in identifying cardio-metabolic risk among youth. Objective The objective of this study was to evaluate the utility of BMI and WC percentiles and WtHR to distinguish adolescents with and without cardio-metabolic risk. Methods A cross-sectional analysis of data from 6097 adolescents aged 10–13 years who participated in the HEALTHY study was conducted. Receiver operating characteristic curves determined the discriminatory ability of BMI and WC percentiles and WtHR. Results The discriminatory ability of BMI percentile was good (area under the curve [AUC] ≥ 0.80) for elevated insulin and clustering of ≥3 risk factors, with optimal cut-points of 96 and 95, respectively. BMI percentile performed poor to fair (AUC = 0.57–0.75) in identifying youth with the majority of individual risk factors examined (elevated glucose, total cholesterol, low-density lipoprotein, blood pressure, triglycerides and high-density lipoprotein). WC percentile and WtHR performed similarly to BMI percentile. Conclusions The current definition of obesity among US children performs well at identifying adolescents with elevated insulin and a clustering of ≥3 cardio-metabolic risk factors. Evidence does not support WC percentile or WtHR as superior screening tools compared with BMI percentile for identifying cardio-metabolic risk.

BACKGROUND AND OBJECTIVES:Regular aerobic and muscle-strengthening physical activity in youth has been positively associated with health and may help prevent obesity. The purpose of this study is to provide reference values on 4 core, upper, and lower body measures of muscle strength among US children and adolescents and to investigate the association between these measures of strength and weight status.METHODS:We assessed muscular strength using 4 different tests (plank, modified pull-up, knee extension, and grip strength) in 1224 youth aged 6 to 15 years collected during the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Mean and median estimates are provided by gender, age, and weight status. Weight status was defined based on standard categories of obesity, overweight, normal weight, and underweight using the gender-specific BMI-for-age Centers for Disease Control and Prevention growth charts.RESULTS:There were significant positive trends with age for each of the strength tests (P < .001) except the modified pull-up among girls. The length of time the plank was held decreased as weight status increased for both girls and boys (P < .001). As weight status increased the number of modified pull-ups decreased (P < .001 boys and girls). Scores on the knee extension increased as weight status increased (P < .01). Grip strength increased as weight status increased (P < .01).CONCLUSIONS:Increasing weight status had a negative association with measures of strength that involved lifting the body, but was associated with improved performances on tests that did not involve lifting the body.

BACKGROUND Seafood is part of a healthy diet, but seafood can also contain methyl mercury-a neurotoxin. OBJECTIVE The objective was to describe seafood consumption in US adults and to explore the relation between seafood consumption and blood mercury. DESIGN Seafood consumption, obtained from a food-frequency questionnaire, and blood mercury data were available for 10,673 adults who participated in the 2007-2010 NHANES-a cross-sectional nationally representative sample of the US population. Seafood consumption was categorized by type (fish or shellfish) and by frequency of consumption (0, 1-2, 3-4, or ≥5 times/mo). Linear trends in geometric mean blood mercury concentrations by frequency of seafood consumption were tested. Logistic regression analyses examined the odds of blood mercury concentrations ≥5.8 μg/L (as identified by the National Research Council) based on frequency of the specific type of seafood consumed (included in the model as continuous variables) adjusted for sex, age, and race/Hispanic origin. RESULTS In 2007-2010, 83.0% ± 0.7% (±SE) of adults consumed seafood in the preceding month. In adults consuming seafood, the blood mercury concentration increased as the frequency of seafood consumption increased (P < 0.001). In 2007-2010, 4.6% ± 0.39% of adults had blood mercury concentrations ≥5.8 μg/L. Results of the logistic regression on blood mercury concentrations ≥5.8 μg/L showed no association with shrimp (P = 0.21) or crab (P = 0.48) consumption and a highly significant positive association with consumption of high-mercury fish (adjusted OR per unit monthly consumption: 4.58; 95% CI: 2.44, 8.62; P < 0.001), tuna (adjusted OR: 1.14; 95% CI: 1.10, 1.17; P < 0.001), salmon (adjusted OR: 1.14; 95% CI: 1.09, 1.20; P < 0.001), and other seafood (adjusted OR: 1.12; 95% CI: 1.08, 1.15; P < 0.001). CONCLUSION Most US adults consume seafood, and the blood mercury concentration is associated with the consumption of tuna, salmon, high-mercury fish, and other seafood.

OBJECTIVES: Rural populations are generally older, sicker, and poorer than their urban counterparts. Few studies have examined differences in dietary patterns by urbanization that may mirror differences in health by urbanization. Our objective is provide national estimates of dietary patterns among adults by urbanization level. METHODS: Using a single 24 hour recall from NHANES 2013–2016, we estimated the mean consumption of fruits, vegetables, % of calories from added sugars and % of calories from saturated fats, by age, sex, education, race and Hispanic origin, and urbanization level among US adults aged 20 and over (n = 9939). We used SUDAAN to conduct all analyses and we evaluated differences between groups using a t statistic and tests of trend across ordinal variables using orthogonal contrast matrices. RESULTS: During 2013–2016, the average fruit intake (cup equivalence) was 0.9 (SE 0.03) for both men and women. After adjustment by age, education level, and race and Hispanic origin, fruit intake increased with higher level of urbanization, from 0.6 (SE 0.07) in rural areas, to 0.9 (SE 0.05) in medium or small urban areas, to 1.0 (SE 0.04) in large urban areas among men. After adjustment, differences by urbanization were not significant for women. The average % of calories from added sugars on a given day was 12% (SE 0.2) for both men and women. After adjustment, added sugars intake decreased with higher level of urbanization, from 14.0% (SE 0.9) in rural areas, to 12.6% (SE 0.3) in medium to small urban areas, to 12.0% (SE 0.2) in large urban areas among women. A similar pattern was also observed among men. There were no differences in vegetable consumption or % of energy from saturated fat by level of urbanization. CONCLUSIONS: Disparities in dietary patterns exist by urbanization. Additional research may show how these differences impact health and identify opportunities to improve health in rural communities. FUNDING SOURCES: The National Center for Health Statistics and the US Centers for Disease Control and Prevention funded this study.

Background: Reducing sugar-sweetened beverage (SSB) consumption is a recommended strategy to promote optimal health. Objective: The objective was to describe trends in SSB consumption among youth and adults in the United States. Design: We analyzed energy intake from SSBs among 22,367 youth aged 2–19 y and 29,133 adults aged $20 y who participated in a 24-h dietary recall as part of NHANES, a nationally representative sample of the US population with a cross-sectional design, between 1999 and 2010. SSBs included soda, fruit drinks, sports and energy drinks, sweetened coffee and tea, and other sweetened beverages. Patterns of SSB consumption, including location of consumption and meal occasion associated with consumption, were also examined. Results: In 2009–2010, youth consumed a mean (6SE) of 155 6 7 kcal/d from SSBs and adults consumed an age-adjusted mean (6SE) of 151 6 5 kcal/d from SSBs—a decrease from 1999 to 2000 of 68 kcal/d and 45 kcal/d, respectively (P-trend , 0.001 for each). In 2009–2010, SSBs contributed 8.0% 6 0.4% and 6.9% 6 0.2% of daily energy intake among youth and adults, respectively, which reflected a decrease compared with 1999–2000 (P-trend , 0.001 for both). Decreases in SSB consumption, both in the home and away from home and also with both meals and snacks, occurred over the 12-y study duration (P-trend , 0.01 for each). Conclusion: A decrease in SSB consumption among youth and adults in the United States was observed between 1999 and 2010. Am J Clin Nutr doi: 10.3945/ajcn.112.057943.

BACKGROUND AND OBJECTIVES: The surveillance of children’s growth reflects a population’s nutritional status and risk for adverse outcomes. This study aimed to describe trends in length-for-age, weight-for-age, weight-for-length, and early childhood weight gain among US children aged 6 to 23 months. METHODS: We analyzed NHANES data from 1976–1980, 1988–1994, 1999–2002, 2003–2006, 2007–2010, and 2011–2014. We estimated z scores < –2 (low) and ≥+2 (high) in comparison with World Health Organization growth standards for each indicator. Weight gain (relative to sex-age–specific medians) from birth until survey participation was estimated. Trends were assessed by low birth weight status and race/Hispanic origin. Race/Hispanic origin trends were assessed from 1988–1994 to 2011–2014. RESULTS: In 2011–2014, the prevalence of low and high length-for-age was 3.3% (SE, 0.8) and 3.7% (SE, 0.8); weight-for-age was 0.6% (SE, 0.3) and 7.0% (SE, 1.1); and weight-for-length was 1.0% (SE, 0.4) and 7.7% (SE, 1.2). The only significant trend was a decrease in high length-for-age (5.5% in 1976–1980 vs 3.7% in 2011–2014; P = .04). Relative weight gain between birth and survey participation did not differ over time, although trends differed by race/Hispanic origin. Non-Hispanic black children gained more weight between birth and survey participation in 2011–2014 versus 1988–1994, versus no change among other groups. CONCLUSIONS: Between 1976–1980 and 2011–2014, there were no significant trends in low or high weight-for-age and weight-for-length among 6- to 23-month-old children whereas the percent with high length-for-age decreased. A significant trend in relative weight gain between birth and survey participation was observed among non-Hispanic black children.

Objective: A recent, cross-sectional analysis of adults found that the hip circumference divided by height1.5 minus 18 (the body adiposity index, BAI) was strongly correlated (r = 0.79) with percent body fat determined by dual energy X-ray absorptiometry. The BAI was proposed as a more accurate index of body fatness than BMI. We examined whether BAI was more strongly related, than was BMI and waist circumference, to skinfold thicknesses and levels of various risk factors for coronary heart disease. Design and Methods: Cross-sectional analyses of adults (n = 14,263 for skinfold thickness; n=6291 for fasting lipid levels) in the National Health and Nutrition Examination Survey (NHANES) III, 1988-1994. Results: As compared with BMI and waist circumference, we found that BAI was less strongly associated with the skinfold sum and with risk factor levels. For example, correlations with the skinfold sum were r = 0.79 (BMI) vs. r = 0.70 (BAI) among men, and r = 0.86 (BMI) vs. r = 0.79 (BAI) among women; p < 0.001 for the difference between each pair of correlations. An overall index of the 7 risk factors was also more strongly associated with BMI and waist circumference than BAI in analyses stratified by sex, race-ethnicity and age. Multivariable analyses indicated that if BMI was known, BAI provided little additional information on risk factor levels. Conclusions: Based on the observed associations with risk factor levels and skinfold thicknesses, we conclude that BAI is unlikely to be a better index of adiposity than BMI.

Objectives:To examine trends in preventive asthma medication (PAM) use among children with current asthma in the United States from 1988 to 2008.Methods:We performed a cross-sectional analysis of PAM use among 2499 children aged 1 to 19 years with current asthma using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) during 3 time periods: 1988–1994, 1999–2002, and 2005–2008. PAMs included inhaled corticosteroids, leukotriene receptor antagonists, long-acting β-agonists, mast-cell stabilizers, and methylxanthines.Results:Among children with current asthma, there was an increase in the use of PAMs from 17.8% (SE: 3.3) in 1988–1994 to 34.9% (SE: 3.3) in 2005–2008 (P < .001 for trend). Adjusting for age, gender, race/ethnicity, and health insurance status, the odds of PAM use were higher in 2005–2008 compared with 1988–1994 (adjusted odds ratio [aOR] = 2.6; 95% confidence interval [CI]: 1.5–4.5). A multivariate analysis, combining all 3 time periods, showed lower use of PAMs among non-Hispanic black (aOR = 0.5 [95% CI: 0.4–0.7]) and Mexican American (aOR = 0.6 [95% CI: 0.4–0.9]) children compared to non-Hispanic white children. PAM use was also lower in 12 to 19 year olds compared with 1 to 5 year olds and also in children who did not have health insurance compared with those who did.Conclusions:Between 1988 and 2008, the use of PAM increased among children with current asthma. Non-Hispanic black and Mexican American children, adolescents aged 12 to 19 years, and uninsured children with current asthma had lower use of PAM.

Until quite recently, there has been a widespread belief in the popular media and scientific literature that the prevalence of childhood obesity is rapidly increasing. However, high quality evidence has emerged from several countries suggesting that the rise in the prevalence has slowed appreciably, or even plateaued. This review brings together such data from nine countries (Australia, China, England, France, Netherlands, New Zealand, Sweden, Switzerland and USA), with data from 467,294 children aged 2-19 years. The mean unweighted rate of change in prevalence of overweight and obesity was +0.00 (0.49)% per year across all age ×sex groups and all countries between 1995 and 2008. For overweight alone, the figure was +0.01 (0.56)%, and for obesity alone -0.01 (0.24)%. Rates of change differed by sex, age, socioeconomic status and ethnicity. While the prevalence of overweight and obesity appears to be stabilizing at different levels in different countries, it remains high, and a significant public health issue. Possible reasons for the apparent flattening are hypothesised. Refereed/Peer-reviewed

Article Title And Bibliographic Information Is there a relationship between birth weight and subsequent growth on the development of dental caries at 5 years of age? A cohort study. Kay EJ, Northstone K, Ness A, Duncan K, Crean SJ. Community Dent Oral Epidemiol 2010;38:408-14. Reviewers Bruce A. Dye, DDS, MPH, Cynthia L. Ogden, PhD, MRP Purpose/Question Do height and weight at birth and subsequent growth affect caries development? Source of Funding Partial support through Avon Longitudinal Study of Parents and Children from the UK Medical Research Council, the Wellcome Trust, and the University of Bristol Type of Study/Design Cohort study Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Not applicable

Terminology and measures used in studies of weight and adiposity in children can be complex and confusing. Differences arise in metrics, terminology, reference values, and reference levels. Most studies depend on body mass index (BMI) calculated from weight and height, rather than on more direct measures of body fatness. Definitions of overweight and obesity are generally statistical rather than risk-based and use a variety of different reference data sets for BMI. As a result, different definitions often do not give the same results. A basic problem is the lack of strong evidence for any one particular definition. Rather than formulate the question as being one of how to define obesity, it might be useful to consider what BMI cut-points best predict future health risks and how efficiently to screen for such risks. The answers may be different for different populations. In addition, rather than depending solely on BMI to make screening decisions, it is likely to be useful to also consider other factors, including not only race-ethnicity, sex and age, but also factors such as family history. Despite their limitations, BMI-based definitions of overweight and obesity provide working practical definitions that are valuable for general public health surveillance and screening.

Background: The 2000 Centers for Disease Control and Prevention (CDC) growth charts included lambda-mu-sigma (LMS) parameters intended to calculate smoothed percentiles from only the 3rd to the 97th percentile. Objective: The objective was to evaluate different approaches to describing more extreme values of BMI-for-age by using simple functions of the CDC growth charts. Design: Empirical data for the 99th and the 1st percentiles of body mass index (BMI)-for-age were calculated from the data set used to construct the growth charts and were compared with estimates extrapolated from the CDC-supplied LMS parameters and to various functions of other smoothed percentiles. A set of reestimated LMS parameters that incorporated a smoothed 99th percentile were also evaluated. Results: Extreme percentiles extrapolated from the CDC-supplied LMS parameters did not match well to the empirical data for the 99th percentile. A better fit to the empirical data was obtained by using 120% of the smoothed 95th percentile. The empirical first percentile was reasonably well approximated by extrapolations from the LMS values. The reestimated LMS parameters had several drawbacks and no clear advantages. Conclusions: Several approximations can be used to describe extreme high values of BMI-for-age with the use of the CDC growth charts. Extrapolation from the CDC-supplied LMS parameters does not provide a good fit to the empirical 99th percentile values. Simple approximations to high values as percentages of the existing smoothed percentiles have some practical advantages over imputation of very high percentiles. The expression of high BMI values as a percentage of the 95th percentile can provide a flexible approach to describing and tracking heavier children. Am J Clin Nutr doi: 10.3945/ajcn.2009.28335.

Parent-reported height and weight are often used to estimate BMI and overweight status among children. The quality of parent-reported data has not been compared to measured data on a national scale for all race/ethnic groups in the United States. Parent-reported height and weight for 2-17-year-old children in two national health interview surveys--the 1999-2004 National Health Interview Survey (NHIS) and the 2003-2004 National Survey of Children's Health (NSCH)--were compared to measured values from a national examination survey-the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Compared to measured data, parent-reported data overestimated childhood overweight in both interview surveys. For example, overweight prevalence among 2-17-year-olds was 25% (s.e. 0.2) using parent-reported NHIS data vs. 16% (s.e. 0.6) using measured NHANES data. Parent-reported data overestimated overweight among younger children, but underestimated overweight among older children. The discrepancy between reported and measured estimates arose mainly from reported height among very young children. For children aged 2-11 years, the mean reported height from NHIS was 3-6 cm less than mean measured height from NHANES (P < 0.001) vs. no difference among children aged 16-17 years. Measured data remains the gold standard for surveillance of childhood overweight. Although this analysis compared mean values from survey populations rather than parent-reported and measured data for individuals, the results from nationally representative data reinforce previous recommendations based on small samples that parent-reported data should not be used to estimate overweight prevalence among preschool and elementary school-aged children.

Background: Body mass index (BMI), waist circumference (WC), and the waist-stature ratio (WSR) are considered to be possible proxies for adiposity. Objective: The objective was to investigate the relations between BMI, WC, WSR, and percentage body fat (measured by dual-energy X-ray absorptiometry) in adults in a large nationally representative US population sample from the National Health and Nutrition Examination Survey (NHANES). Design: BMI, WC, and WSR were compared with percentage body fat in a sample of 12,901 adults. Results: WC, WSR, and BMI were significantly more correlated with each other than with percentage body fat (P < 0.0001 for all sex-age groups). Percentage body fat tended to be significantly more correlated with WC than with BMI in men but significantly more correlated with BMI than with WC in women (P < 0.0001 except in the oldest age group). WSR tended to be slightly more correlated with percentage body fat than was WC. Percentile values of BMI, WC, and WSR are shown that correspond to percentiles of percentage body fat increments of 5 percentage points. More than 90% of the sample could be categorized to within one category of percentage body fat by each measure. Conclusions: BMI, WC, and WSR perform similarly as indicators of body fatness and are more closely related to each other than with percentage body fat. These variables may be an inaccurate measure of percentage body fat for an individual, but they correspond fairly well overall with percentage body fat within sex-age groups and distinguish categories of percentage body fat.

To compare the prevalence of shortness, underweight, and overweight by using the Centers for Disease Control and Prevention (CDC) 2000 and the World Health Organization (WHO) 2006 growth charts. These comparisons are undertaken with 2 sets of cutoff values.Data from the National Health and Nutrition Examination Survey 1999-2004 were used to calculate the prevalence estimates in US children aged 0 to 59 months (n = 3920). Cutoff values commonly used in the United States, on the basis of the 5th percentile of height-for-age to define shortness, the 5th percentile of weight-for-height or weight-for-age to define underweight, and the 95th percentile of weight-for-height or body mass index-for-age to define overweight were compared with the cutoff values recommended by WHO, which use-2 z-score (equivalent to 2.3rd percentile) to define shortness and underweight andor=2 z-score (equivalent to 97.7th percentile) to define overweight. A comparison with the same cutoff values (5th and 95th) in the 2 charts was also performed.Applying the 5th or 95th percentile, we observed a higher prevalence of shortness and overweight for all the age groups when the WHO 2006 growth charts were used than when the CDC 2000 growth charts were used. Applying the 5th percentile to the WHO 2006 charts produced lower rates of underweight than did the CDC 2000 charts. However, applying the 5th or 95th percentiles to the CDC 2000 charts and the WHO-recommended cutoff values of -2 or +2 z-score to the WHO charts produced smaller differences in the prevalence of shortness and overweight than were seen when the 5th and 95th percentiles were applied to both the CDC and WHO charts.Estimates of the prevalence of key descriptors of growth in children aged 0 to 59 months vary by the chart used and the cutoff values applied. The use of the 5th and 95th percentiles for the CDC growth charts and the 2.3rd and 97.7th percentiles for the WHO growth charts appear comparable in the prevalence of shortness and overweight, but not underweight. If practitioners were to use the WHO growth charts, it might be more appropriate to adopt the WHO recommended cutoff values as well, but this would be a change for office practice.

About one-third of U.S. youth consumed nuts on a given day in 2009–2012. Older youth were less likely to consume nuts than younger youth. More non-Hispanic white than non-Hispanic black or Hispanic youth consumed nuts. More youth living in households at or above 350% of the poverty level consumed nuts than youth in households below 130% poverty or at 130% up to 350% of the poverty level. Although previous guidance suggested that timing of the introduction of nuts into children’s diets may play a role in allergies, this guidance has recently been revised. There is a lack of evidence linking early introduction of nuts to development of allergy. This analysis did not include infants under the age of 1 year but did find that consumption of nuts was higher among younger children. More than one-third of nut consumption among youth (39.5%) occurs as a single-item food (i.e., not as an ingredient in other foods). Nuts are an alternate source of protein, especially for youth. Nuts are also high in mono- and polyunsaturated fats and fiber, and are a rich source of antioxidants such as selenium and vitamin E. Some nuts, especially walnuts and pumpkin seeds, are good sources of omega-3 fatty acids.

Research has linked fetal environment to subsequent adult disease. This study examines the extent to which infants born small-for-gestational age (SGA) were at risk for high cholesterol levels in early childhood (ages 4-6 years). Data were obtained from 1727 children aged 4-6 years who participated in the cross-sectional third US National Health and Nutrition Examination Survey and had both birth certificates and blood cholesterol information. The odds of having moderately elevated (170-199 mg/dL) or high (> or =200 mg/dL) serum total cholesterol after being born SGA were determined after controlling for sex, race/ethnicity, education of household head, saturated fat intake, parental history of high cholesterol and overweight status. Approximately 11% of participants were SGA. Proportions of children with moderately elevated and high cholesterol levels were approximately 28 and 8%, respectively. SGA children were almost twice as likely (odds ratio 1.97, 95% confidence interval [0.8, 4.8]) to have high cholesterol vs. low cholesterol than non-SGA children, although the result was not statistically significant. Multiple linear regression demonstrated a similar inverse, non-significant relationship between gestation-adjusted birthweight and cholesterol (beta = -2.3, P = 0.33). These data indicate a possible association between reduced fetal growth, represented by birthweight adjusted for gestational age, and increased cholesterol levels in early childhood.

Although the body mass index (BMI, kg m(-2)) is widely used as a measure of adiposity, it is a measure of excess weight, rather than excess body fat. It has been suggested that skinfold thicknesses be measured among overweight children to confirm the presence of excess adiposity.The present study examined the additional information provided by skinfold thicknesses on body fatness, beyond that conveyed by BMI-for-age, among healthy 5- to 18-years old (n = 1196).Total body dual-energy X-ray absorptiometry (DXA) provided estimates of % body fat, and the sum of two skinfolds (triceps and subscapular) was used as an indicator of the overall skinfold thickness.As assessed by the multiple R(2)s and the residuals of various regression models, information on the skinfold sum significantly ( p0.001) improved the prediction of body fatness beyond that obtained with BMI-for-age. For example, the use of the skinfold sum, in addition to BMI-for-age, increased the multiple R(2)s for predicting % body fat from 0.81 to 0.90 (boys), and from 0.82 to 0.89 (girls). The use of the skinfold sum also reduced the overall prediction errors (absolute value of the residuals) for % body fat by 20-30%, but these reductions varied substantially by BMI-for-age. Among overweight children, defined by a BMI-for-age/=95th percentile, the skinfold sum reduced the predication errors for % body fat by only 7-9%.Although skinfold thicknesses, when used in addition to BMI-for-age, can substantially improve the estimation of body fatness, the improvement among overweight children is small.

Obesity is associated with health risks (1,2). Monitoring the prevalence of obesity is relevant for public health programs that focus on reducing or preventing obesity. No significant changes were seen in either adult or childhood obesity prevalence in the United States between 2003-2004 and 2011-2012 (3). This report provides the most recent national data on obesity prevalence by sex, age, and race and Hispanic origin, using data for 2011- 2014. Overall prevalence estimates from 1999-2000 through 2013-2014 are also presented.

OBJECTIVES: To describe the contribution of whole fruit, including discrete types of fruit, to total fruit consumption and to investigate differences in consumption by sociodemographic characteristics. METHODS: We analyzed data from 3129 youth aged 2 to 19 years from the National Health and Nutrition Examination Survey, 2011 to 2012. Using the Food Patterns Equivalents Database and the What We Eat in America 150 food groups, we calculated the contribution of whole fruit, 100% fruit juices, mixed fruit dishes, and 12 discrete fruit and fruit juices to total fruit consumption. We examined differences by age, gender, race and Hispanic origin, and poverty status. RESULTS: Nearly 90% of total fruit intake came from whole fruits (53%) and 100% fruit juices (34%) among youth aged 2 to 19 years. Apples, apple juice, citrus juice, and bananas were responsible for almost half of total fruit consumption. Apples accounted for 18.9% of fruit intake. Differences by age were predominately between youth aged 2 to 5 years and 6 to 11 years. For example, apples contributed a larger percentage of total fruit intake among youth 6 to 11 years old (22.4%) than among youth 2 to 5 years old (14.6%), but apple juice contributed a smaller percentage (8.8% vs 16.8%), P < .05. There were differences by race and Hispanic origin in intake of citrus fruits, berries, melons, dried fruit, and citrus juices and other fruit juices. CONCLUSIONS: These findings provide insight into what fruits US youth are consuming and sociodemographic factors that may influence consumption.

Consumption of fast food has been linked to weight gain in adults (1). Fast food has also been associated with higher caloric intake and poorer diet quality in children and adolescents (2). From 1994 through 2006, caloric intake from fast food increased from 10% to 13% among children aged 2-18 years (3). This report presents the most recent data on the percentage of calories consumed from fast food among U.S. children by sex, age group, race and Hispanic origin, poverty status, and weight status.

INTRODUCTION: Although decline in muscle mass and quality and resulting declines in muscle strength are associated with aging, more research is needed in general populations to assess the utility of handgrip strength as an indicator of muscle strength and cardiovascular disease risk. METHODS: Data from 4,221 participants aged ≥20 years in the 2011–2012 cycle of National Health and Nutrition Examination Survey were analyzed during 2014–2015. Standing isometric relative handgrip strength (calculated as maximal absolute handgrip strength from both hands divided by BMI) was used to predict cardiovascular biomarkers, including blood pressure (measured systolic and diastolic blood pressure); serum lipids (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides); and plasma insulin and glucose. RESULTS: Results from regression analyses showed that higher relative grip strength was significantly associated with lower systolic blood pressure, triglycerides, and plasma insulin and glucose, and higher high-density lipoprotein cholesterol in male and female participants (p

Background: The Dietary Guidelines for Americans 2010 state that Americans should increase their intake of low fat and non-fat milk and milk products including yogurt. Objective: This analysis exam...

Studies in a variety of countries have shown increases in the prevalence of overweight among children in recent years. These increases have given rise to concern about children's health and well-being. The terminology used in these studies varies considerably. However, whatever the terminology used, such studies are generally based on weight [expressed as body mass index (BMI), a measure of weight for height, calculated as weight in kilograms divided by the square of height in meters] and not on body fatness per se. There are many different BMI references that can be used to define childhood overweight or obesity. Children are defined as overweight for population surveillance purposes using a variety of BMI cut points. BMI is a screening tool, not a diagnostic tool. Children with a BMI over these cut points do not necessarily have clinical complications or health risks related to overfatness. More in-depth assessment of individual children is required to ascertain health status. The definitions of overweight generally used are working definitions that are valuable for general public health surveillance, screening and similar purposes.

Objectives: The prevalence of childhood overweight in the United States has markedly increased over the last 30 years. We examined differences in the secular trends for BMI, weight, and height among white, black, and Mexican-American children. Research Methods and Procedures: Analyses were based on nationally representative data collected from 2 to 17 year olds in four examinations (1971–1974 through 1999–2002). Results: Overall, black children experienced much larger secular increases in BMI, weight, and height than did white children. For example, over the 30-year period, the prevalence of overweight increased ∼3-fold (4% to 13%) among 6- to 11-year-old white children but 5-fold (4% to 20%) among black children. In most sex-age groups, Mexican-American children experienced increases in BMI and overweight that were between those experienced by blacks and whites. Race/ethnicity differences were less marked among 2 to 5 year olds, and in this age group, white children experienced the largest increase in overweight (from 4% to 9%). In 1999–2002, the prevalence of extreme BMI levels (≥99th percentile) reached 6% to 7% among black girls and Mexican-American boys. Discussion: Because of the strong tracking of childhood BMI levels into adulthood, it is likely that the secular increases in childhood overweight will greatly increase the burden of adult disease. The further development of obesity interventions in different racial/ethnic groups should be emphasized.

The prevalence of overweight, as assessed by a high body mass index (kg/m), has greatly increased among children and adolescents over the last three decades. Because body mass index is a measure of excess weight rather than excess body fatness, it is important to understand the ability of a high level to identify children who truly have excess adiposity. This review covers the measurement and classification of overweight and obesity, the expression of body composition data, and the relation of body mass index to adiposity.Although adiposity has typically been expressed as percentage body fat, the use of the fat mass index (fat mass/height) and the fat-free mass index (fat-free mass/height) may provide more information. For example, body mass index differences among relatively thin children have been found to largely reflect differences in fat-free mass index, whereas differences among relatively heavy children are primarily due to differences in fat mass index. In addition, the ability of overweight to identify obese children is greatly influenced by the cutpoints selected for body mass index and adiposity. The use of inappropriate cutpoints, rather than the limitations of body mass index, may account for the frequently reported finding that many obese children are not overweight.The use of fat mass index and fat-free mass index in expressing body composition data allows one to easily assess the contribution of each to body mass index. If appropriate cutpoints are used, a high body mass index level is a moderately sensitive and a very specific indicator of excess adiposity among children.

Overweight and obesity have been increasing in many countries. Our objective is to describe the trends in overweight and obesity occurring in the Mexican-American population in the United States. Data on measured height and weight for Mexican Americans come from the following surveys: the Hispanic Health and Nutrition Examination Survey (HHANES, 1982-84), the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94), and NHANES 1999-2002. In 1999-2002, 73% of Mexican-American adults were overweight and 33% were obese. Obesity increased between NHANES III and NHANES 1999-2002, from 24% to 27% for men and from 35% to 38% for women. Increases were also seen for children and adolescents. The Mexican-American population in the United States, both children and adults, is showing trends in overweight and obesity over time that are similar to those seen in other segments of the U.S. population and indeed in many countries.

INTRODUCTION: Cardiovascular disease remains an important cause of death in the U.S. where veterans of the U.S. Armed Forces represent a significant segment of the population. Limited national estimates of cardiovascular disease risk factors using physical measurements and reported veteran status in the U.S. civilian population have been reported. The purpose of this study was to compare the prevalence of cardiovascular disease risk factors among veteran and non-veteran men in the U.S. civilian population. METHODS: Using data from the 2009–2012 National Health and Nutrition Examination Surveys, 1,107 veteran and 3,972 non-veteran men were identified for this study (analyzed in 2014–2015). Differences in hypertension, dsylipidemia, diabetes, obesity, and smoking between veterans and non-veterans were compared using chi-square and t-tests. Predicted prevalence from multivariable logistic regression models adjusted for age, race/Hispanic origin, and poverty level were used to assess whether previous military service was associated with having a cardiovascular disease risk factor. RESULTS: Veteran men were older than non-veteran men (59.9 years vs 43.4 years) and were more likely to be non-Hispanic white (79.9% vs 65.7%). Adjusted predicted prevalence estimates show that veterans were more likely than non-veterans to be obese (42.6% vs 33.7%, p

BACKGROUND: Consuming seafood has health benefits, but seafood can also contain methylmercury, a neurotoxicant.Exposure to methylmercury affects children at different stages of brain development, including during adolescence. OBJECTIVE: The objective was to examine seafood consumption and blood mercury concentrations in US youth. METHODS: In the 2009–2012 NHANES, a cross-sectional nationally representative sample of the US population, seafood consumption in the past 30 d and blood mercury concentrations on the day of examination were collected from 5656 youth aged 1–19 y. Log-linear regression was used to examine the association between frequency of specific seafood consumption and blood mercury concentration, adjusting for race/Hispanic origin, sex, and age. RESULTS: In 2009–2012, 62.4% ± 1.4% (percent ± SE) of youth consumed any seafood in the preceding month; 38.4% ± 1.4% and 48.5% ± 1.5% reported consuming shellfish and fish, respectively. In 2009–2012, the geometric mean blood mercury concentration was 0.50 ± 0.02 μg/L among seafood consumers and 0.27 ± 0.01 μg/L among those who did not consume seafood. Less than 0.5% of youth had blood mercury concentrations ≥5.8 μg/L. In adjusted log-linear regression analysis, no significant associations were observed between frequency of breaded fish or catfish consumption and blood mercury concentrations, but frequency of consuming certain seafood types had significant positive association with blood mercury concentrations: high-mercury fish (swordfish and shark) [exponentiated β coefficient (expβ): 2.40; 95% CI: 1.23, 4.68]; salmon (expβ: 1.41; 95% CI: 1.26, 1.55); tuna (expβ: 1.38; 95% CI: 1.29, 1.45); crabs (expβ: 1.35; 95% CI: 1.17, 1.55); shrimp (expβ: 1.12; 95% CI: 1.05, 1.20), and all other seafood (expβ: 1.23; 95% CI: 1.17, 1.32). Age-stratified log-linear regression analyses produced similar results. CONCLUSION: Few US youth have blood mercury concentrations ≥5.8 μg/L, although more than half of US youth consumed seafood in the past month.

Objective-This report presents national anthropometric reference data for all ages of the U.S. population in 2003-2006, adding to results published previously from 1960-2002. Methods-Data are from the National Health and Nutrition Examination Survey (NHANES), a complex, stratified, and multistage probability sample of the civilian, noninstitutionalized U.S. population. Anthropometry measurements were obtained from 19,593 survey participants. The anthropometric measures included weight, height, recumbent length, circumferences, limb lengths, and skinfold thickness measurements. Results-The tables in this report include weighted population means, standard errors of the means, and selected percentiles of body measurement values. Because measurements varied by sex and age (as well as race and ethnicity in adults), results are reported by these subgroups. Conclusions-These latest NHANES data add to the knowledge about trends in child growth and development and trends in the distribution of body measurements, such as weight and height, in the U.S. population .

The availability of epidemiologic data on childhood obesity has increased in response to public health concerns regarding childhood obesity trends. For example, researchers in several nations have begun to collect school surveillance data to monitor the prevalence of childhood obesity (1–5). Data quality can be variable (6), and researchers investigating obesity must address how to identify biologically implausible values (BIVs) in anthropometric data (height, weight, body mass index (BMI)). This may be of particular concern because height and weight measurements often are collected in non–research settings such as schools and when summarizing very high BMI values. In addition, a unique set of criteria may be needed for longitudinal studies to address biologically implausible change over time, such as weight loss/gain and shrinking/large height changes. The methodological process of identifying BIVs, 1 possible source of measurement error, has not been explored, and researchers have utilized a variety of methods that have not been compared or evaluated. It is not yet known how different methods for the identification of BIVs may affect study results or how often the issue of BIVs is addressed in large epidemiologic studies. Appropriate identification of BIVs will help to minimize measurement error, particularly data-recording and -entry errors, which may otherwise be more difficult to identify (6). Therefore, the current study aimed 1) to track how often large epidemiologic studies in youth address the issue of BIVs, 2) to review available methods for addressing cross-sectional and longitudinal BIVs in youth anthropometric data, and 3) to apply each unique set of BIV criteria to a large longitudinal data set from Get Healthy Philly of low-income minority youth and compare the effects on weight status and BIV prevalence estimates.

Because of the recognized benefits of exclusive breastfeeding,1–7 the American Academy of Pediatrics and the World Health Organization strongly encourage exclusive breastfeeding for the first 6 months of life.7,8 Unfortunately, national goals for exclusive breastfeeding in the United States are not yet established, at least in part because of a lack of data. The Third National Health and Nutrition Examination Survey (NHANES III) sample is nationally representative and particularly valuable in providing data on exclusive breastfeeding. We used NHANES III data to examine the prevalence of exclusive breastfeeding among US infants to obtain baseline data for program evaluation and public health policymaking.

Data from the National Health and Nutrition Examination Survey, 2009-2010. Almost 40% (38.2%) of adults consumed nuts on a given day. More non-Hispanic white (43.6%) than non-Hispanic black (23.7%) or Hispanic (25.5%) adults consumed nuts. Approximately 80% of nuts consumed (84.0% by men and 79.7% by women) were nuts or seeds as single-item foods or nut butters.

Objective-This report presents national anthropometric reference data for all ages of the U.S. population in 2007-2010, adding to results published previously from the years 1960-2006. Methods-Data are from the National Health and Nutrition Examination Survey (NHANES), a complex, stratified, and multistage probability sample of the civilian noninstitutionalized U.S. population. Anthropometry measurements were obtained from 20,015 survey participants. The anthropometric measures included weight, height, recumbent length, circumferences, limb lengths, and skinfold thickness measurements. Results-The tables in this report include weighted population means, standard errors of the means, and selected percentiles of body measurement values. Because measurements varied by sex and age (as well as race and ethnicity in adults), results are reported by these subgroups. Conclusions-These latest NHANES data add to the knowledge about trends in child growth and development and trends in the distribution of body measurements, such as weight and height, in the U.S. population.

Background-Analytic guide lines were first created in 1996 to assist data users in analyzing data from the Third National Health and Nutrition Examination Survey (NHANES III),conducted from 1988 to 1994 by the Centers for Disease Control and Prevention's National Center for Health Statistics. NHANES became a continuous annual survey in 1999, with data released to the public in 2-year intervals. In 2002, 2004, and 2006, guidelines were created and posted on the NHANES website to assist analysts in understanding the key issues related to analyzing data from 1999 onward. This report builds on these previous guidelines and provides the first comprehensive summary of analytic guidelines for the 1999-2010 NHANES data. Objectives-This report provides general guidelines for researchers in analyzing 1999-2010 NHANES publicly released data. Information is presented on key issues related to NHANES data, including sample design, demographic variables, and combining survey cycles. Guidance is also provided on data analysis, including the use of appropriate survey weights, calculating variance estimations, determining the reliability of estimates, age adjustment, and computing population counts.

Background Food insecurity can put children at greater risk of obesity because of altered food choices and nonuniform consumption patterns. Objective We examined the association between obesity and both child-level food insecurity and personal food insecurity in US children. Design Data from 9,701 participants in the National Health and Nutrition Examination Survey, 2001-2010, aged 2 to 11 years were analyzed. Child-level food insecurity was assessed with the US Department of Agriculture's Food Security Survey Module based on eight child-specific questions. Personal food insecurity was assessed with five additional questions. Obesity was defined, using physical measurements, as body mass index (calculated as kg/m 2 ) greater than or equal to the age- and sex-specific 95th percentile of the Centers for Disease Control and Prevention growth charts. Logistic regressions adjusted for sex, race/ethnic group, poverty level, and survey year were conducted to describe associations between obesity and food insecurity. Results Obesity was significantly associated with personal food insecurity for children aged 6 to 11 years (odds ratio=1.81; 95% CI 1.33 to 2.48), but not in children aged 2 to 5 years (odds ratio=0.88; 95% CI 0.51 to 1.51). Child-level food insecurity was not associated with obesity among 2- to 5-year-olds or 6- to 11-year-olds. Conclusions Personal food insecurity is associated with an increased risk of obesity only in children aged 6 to 11 years. Personal food-insecurity measures may give different results than aggregate food-insecurity measures in children.

Background The sagittal abdominal diameter (SAD) measured in supine position is an alternative adiposity indicator that estimates the quantity of dysfunctional adipose tissue in the visceral depot. However, supine SAD’s distribution and its association with health risk at the population level are unknown. Here we describe standardized measurements of SAD, provide the first, national estimates of the SAD distribution among US adults, and test associations of SAD and other adiposity indicators with prevalent dysglycemia. Methods and Findings In the 2011–2012 National Health and Nutrition Examination Survey, supine SAD was measured (“abdominal height”) between arms of a sliding-beam caliper at the level of the iliac crests. From 4817 non-pregnant adults (age ≥20; response rate 88%) we used sample weights to estimate SAD’s population distribution by sex and age groups. SAD’s population mean was 22.5 cm [95% confidence interval 22.2–22.8]; median was 21.9 cm [21.6–22.4]. The mean and median values of SAD were greater for men than women. For the subpopulation without diagnosed diabetes, we compared the abilities of SAD, waist circumference (WC), and body mass index (BMI, kg/m2) to identify prevalent dysglycemia (HbA1c ≥5.7%). For age-adjusted, logistic-regression models in which sex-specific quartiles of SAD were considered simultaneously with quartiles of either WC or BMI, only SAD quartiles 3 (p

Introduction:In disaster situations, timely surveillance systems that provide illness, injury, and mortality information to public health officials and hospitals are essential for planning and evaluating interventions.Objectives:To describe flood surveillance methodology, the impact of the event on hospitals, and the number of daily patient visits due to selected illnesses and injuries before, during, and after severe flooding in southeastern Louisiana in May 1995.Methods:Survey of disaster-area hospitals regarding flood impact. Emergency department surveillance of injuries and illnesses for the week before, the two days during, and the week after the flood.Results:There occurred an increase in the number of persons who drowned or were injured that presented to the moderately affected hospitals during the storm, but there was no increase in visits for gastroenteritis to any group of hospitals. Services were disrupted in more than half of hospitals. The severely affected hospitals had the least variation in the average number of daily visits. None of the drownings were reported by those hospitals that reported severe service disruption.Conclusions:Data should be collected from all hospitals in or near disaster areas, even if they were not directly affected by the disaster. Public education about the danger of drowning during flash flooding must be improved. The Louisiana experience emphasizes the need for a disaster-preparedness plan for rapid surveillance of illnesses and injuries.

Background: Several different sets of reference body mass index (BMI) values are available to define overweight in children. Objective: The objective of this study was to compare the prevalence of overweight in US children calculated with 3 sets of reference BMI values: the revised growth charts of the Centers for Disease Control and Prevention (CDC-US growth charts), international standards proposed by Cole et al, and values developed by Must et al. Design: Data for children and adolescents came from cross-sectional nationally representative US surveys: cycles II and III of the National Health Examination Survey (1963-1965 and 1966-1970) and the first, second, and third National Health and Nutrition Examination Surveys: NHANES I (1971-1974), II (1976-1980), and III (1988-1994). The reference values of Cole et al equivalent to a BMI of 25 were compared with the 85th percentiles from the other 2 methods; the values equivalent to a BMI of 30 were compared with the 95th percentiles. Results: The 3 methods gave similar but not identical results. The reference values of Cole et al gave lower estimates than did the CDC-US growth charts for young children but higher estimates for older children. The reference values of Must et al gave much higher prevalences for younger girls than did the other 2 methods. Conclusions: Differences between methods were related to differences in data sets, smoothing methods, and theoretical approaches. All 3 methods are based on statistical criteria and incorporate arbitrary assumptions. These methods should be used cautiously, with awareness of the possible limitations.

Data from the combined National Health and Nutrition Examination Survey (NHANES) and the NHANES National Youth Fitness Survey, 2012. In 2012, about one-quarter of U.S. youth aged 12-15 years engaged in moderate-to-vigorous physical activity for at least 60 minutes daily. Basketball was the most common activity reported among active boys, followed by running, football, bike riding, and walking. Running was the most common activity among active girls, followed by walking, basketball, dancing, and bike riding. The percentage of male youth who were physically active for at least 60 minutes daily decreased as weight status increased. The 2008 Physical Activity Guidelines for Americans, which have been adopted by the First Lady's Let's Move! initiative and the American Academy of Pediatrics, recommend that youth participate in daily moderate-to-vigorous physical activity for at least 60 minutes (1-5). This report presents the most recent national data from 2012 on self-reported physical activity among youth aged 12-15 years, by sex and weight status. This report also describes the most common types of physical activities--outside of school-based physical education (PE) or gym classes--in which youth engage.

Data from the National Health and Nutrition Examination Survey, National Youth Fitness Survey. There were no significant differences by sex in core, lower, or upper body measures of strength for younger boys and girls. In contrast, adolescent boys had higher values than adolescent girls on all measures of strength. Adolescent boys and girls had higher scores than younger boys and girls on the core and lower body strength measures and upper body strength as measured by the grip strength test. Adolescent boys completed more modified pull-ups, a measure of upper body strength, than younger boys. There was no significant difference in the number of modified pull-ups completed between adolescent and younger girls. In 2008, the federal government released the Physical Activity Guidelines for Americans, which provide guidance on the types and amounts of physical activities that provide substantial health benefits for Americans of all ages. Regular physical activity reduces the risk of many adverse health outcomes and helps control the percentage of body fat in children and adolescents (1). This report provides the first nationally representative data on core, upper body, and lower body measures of muscle strength among U.S. children and adolescents aged 6-15 years by sex and age group.

Data from the National Health and Nutrition Examination Survey, 2011-2012. More than one-third (34.9%) of adults were obese in 2011-2012. In 2011-2012, the prevalence of obesity was higher among middle-aged adults (39.5%) than among younger (30.3%) or older (35.4%) adults. The overall prevalence of obesity did not differ between men and women in 2011-2012. Among non-Hispanic black adults, however, 56.6% of women were obese compared with 37.1% of men. In 2011-2012, the prevalence of obesity was higher among non-Hispanic black (47.8%), Hispanic (42.5%), and non-Hispanic white (32.6%) adults than among non-Hispanic Asian adults (10.8%). The prevalence of obesity among adults did not change between 2009-2010 and 2011-2012.