The Association Between Sarcopenia and Cognitive Performance : Data from the National Health and Nutrition Examination Surveys 1999 to 2002

Background: Sarcopenia and cognitive impairment are both age-related diseases. And they have many risk factors in common. However, the association between them has been controversial in recent years.Objective: To investigate the association between sarcopenia and cognitive performance in the U.S. adults through the use of the NHANES data from 1999 to 2002.Methods: A total of 2550 participants were identified in the National Health and Nutrition Examination Surveys Data Base (1999–2002). The independent variable was sarcopenia and the dependent variables was cognitive performance. Men were classified as sarcopenia if appendicular lean mass (ALM) adjusted for BMI (ALMBMI) <0.789, and women<0.512. The cognitive performance was assessed by Digit Symbol Substitution Test (DSST). Higher scores on the DSST indicated better cognitive performance. The covariates included gender, age, race, poverty income ratio, comorbidity index, educational level, physical activity and smoking status.Results: For the primary outcome, our multivariate linear regression analysis indicated that sarcopenia negatively correlated with cognitive performance in the model I (crude OR = 5.18; 95% CI: [3.49–6.87]). The negative association remained significant in the adjusted model II and model III (OR=3.40; 95% CI: [1.91–4.90]; OR=1.50; 95% CI: [0.12–2.89]). The subgroup analysis results indicated that participants without sarcopenia were associated with better cognitive performance was similar in different gender, age, race, poverty income ratio, comorbidity index, educational level, physical activity and smoking status.Conclusions: Participants without sarcopenia were associated with better cognitive performance in a representative sample of older adults in the U.S. We might be able to try to improve cognitive performance by dealing with sarcopenia and provide opportunity for intervention at a younger age and better physical performance.

Association of Poverty Income Ratio with Physical Functioning in a Cohort of Patients with Systemic Lupus Erythematosus

Objective.To examine the association of income relative to the poverty threshold [poverty income ratio (PIR)] with self-reported physical functioning (PF) in a cohort of patients with systemic lupus erythematosus.Methods.We used cross-sectional data on 744 participants from Georgians Organized Against Lupus (GOAL), and secondary analyses used data on 56 participants from a nested pilot study. Primary analyses used multivariable linear regression to estimate the association between PIR (categorized as < 1.00, 1.00–1.99, 2.00–3.99, and ≥ 4.00; lower PIR indicate higher poverty) and PF (scaled subscore from the Medical Outcomes Study Short Form–12 survey; range 0–100, higher scores indicate better functioning). Secondary analyses summarized complementary measures of PF as means or percentages by PIR (categorized as < 1.00, 1.00–1.99, and ≥ 2.00).Results.The mean age of participants was 48.0 years; 6.7% were male; 80.9% were black; and 37.5%, 21.0%, 29.6%, and 12.0% had PIR of < 1.00, 1.00–1.99, 2.00–3.99, and ≥ 4.00, respectively. The overall mean PF score was 45.8 (36.2, 40.7, 55.5, and 61.2 for PIR of < 1.00, 1.00–1.99, 2.00–3.99, and ≥ 4.00). With adjustment, higher PIR remained associated with higher PF scores [2.00–3.99 vs 1.00–1.99: β = 10.9 (95% CI 3.3–18.6); ≥ 4.00 vs 1.00–1.99: β = 16.2 (95% CI 6.4–26.0)]. In secondary analyses, higher PIR was also associated with higher scores for objective physical performance.Conclusion.Our results show that higher income relative to the poverty threshold is associated with better PF across multiple domains, warranting further research into multicomponent functional assessments to develop individual treatment plans and potentially improve socioeconomic disparities in outcomes.

The Co-occurrence of Food Insecurity, Smoking and Obesity in U.S. Adults: National Health and Nutrition Examination Survey (NHANES), 2013–2014 (P04-088-19)

Objectives Tobacco use and diseases related to poor diet rank among the top two causes of premature death in the U.S. Existing research suggests smoking and obesity are each associated with food insecurity (FI), but few studies have documented their co-occurrence in the context of FI. The purpose of this study was to describe the prevalence and correlates of FI with a particular focus on the co-occurrence of obesity and smoking among those who are FI in a nationally representative sample. Methods 5364 non-pregnant adults aged 20+ were selected for analysis from the 2013–2014 NHANES survey cycle. Height and weight were measured. BMI weight class was defined as normal weight (BMI > 18.5 and < 25), overweight (BMI > 25 and < 30) and obese (BMI > 30). Adult food insecurity (yes/no) was defined as full/marginal food security v. low/very low. Rao-Scott chi-square tests were used to compare prevalence rates. A logistic regression model was set up with FI as the dependent variable and demographics (age, race, education, gender, and poverty income ratio), smoking status, and BMI class as independent variables. Analyses were performed according to NHANES analytical guidelines to create nationally representative values. Results The overall prevalence of food insecurity, smoking, and obesity was 14.4% (n = 971), 19.6% (n = 1082), and 38.5% (n = 2060), respectively. The co-occurrence of obesity and smoking in the overall sample was 7.0% (n = 377). Among those who were FI, the prevalence of smoking was 36.6% (v. not FI 16.6%, P < 0.001), obesity was 47.1% (v. not FI 37.0%, P < 0.001), and the co-occurrence of smoking and obesity was 14.4% (v. not FI 5.7%, P < 0.001). In the logistic regression model, significant predictors of FI included: younger age (P = 0.007), lower poverty income ratio (P < 0.001), having a high school education or less (P = 0.002), smoking (P = 0.01) and obesity (P = 0.004). Conclusions Obesity and smoking were independent predictors of FI. Further, among those who were FI, the prevalence of co-occurring smoking and obesity was more than double that of those in the U.S. population without FI. Overall, these findings suggest food insecurity should be considered when developing obesity and smoking cessation-related interventions. Funding Sources None.

Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003–2012

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2012, we investigated the prevalence and characteristics of under-reporting and over-reporting of energy intake (EI) among 19 693 US adults ≥20 years of age. For the assessment of EI, two 24-h dietary recalls were conducted using the US Department of Agriculture Automated Multiple-Pass Method. Under-reporters, acceptable reporters and over-reporters of EI were identified by two methods based on the 95 % confidence limits: (1) for agreement between the ratio of EI to BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI to estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield’s equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming ‘low active’ level of physical activity. The risk of being an under-reporter or over-reporter compared with an acceptable reporter was analysed using multiple logistic regression. Percentages of under-reporters, acceptable reporters and over-reporters were 25·1, 73·5 and 1·4 %, respectively, based on EI:BMR, and 25·7, 71·8 and 2·5 %, respectively, based on EI:EER. Under-reporting was associated with female sex, older age, non-Hispanic blacks (compared with non-Hispanic whites), lower education, lower family poverty income ratio and overweight and obesity. Over-reporting was associated with male sex, younger age, lower family poverty income ratio, current smoking (compared with never smoking) and underweight. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999–2012 (n 28 794). In conclusion, we found that misreporting of EI, particularly under-reporting, remains prevalent and differential in US adults.