Source: National Health and Nutrition Examination Survey
Source: National Health and Nutrition Examination Survey
Questions for Asher Rosinger, Epidemic Intelligence Service Officer and Lead Author of “Sugar-Sweetened Beverage Consumption Among U.S. Adults, 2011–2014” and “Sugar-Sweetened Beverage Consumption Among U.S. Youth, 2011–2014”
Q: Why did you decide to do a report on sugar-sweetened beverage consumption?
AR: Sugar-sweetened beverage consumption has been linked to a myriad of negative health conditions, such as weight gain, dental caries, and type 2 diabetes.
In these reports we wanted to provide the most recent estimates of the calories adults and youth are consuming from sugar-sweetened beverages, what percentage of their daily caloric intake sugar-sweetened beverages represented, and how these patterns differed by sex, age, and race and Hispanic origin.
Q: How do you define a sugar-sweetened beverage?
AR: We defined sugar-sweetened beverages to include regular soda, fruit drinks (including sweetened bottled waters and fruit juices and nectars with added sugars), sports and energy drinks, sweetened coffees and teas, and other pre-sweetened beverages. Sugar-sweetened beverages do not include diet drinks, defined as less than 40 kilocalories (kcal) per 240 mL of the beverage; 100% fruit juice; beverages sweetened by the participant, including coffee and teas; alcohol; or flavored milks. This definition is consistent with previous reports.
Q: Is this the first time NHANES has released a report on this topic? If not, where is trend data available?
AR: NHANES has reported on sugar-sweetened beverage consumption in a previous report and most recently in a journal article in the American Journal of Clinical Nutrition by Kit et al, which specifically looked at trends from 1999–2010 among youth and adults. We used the same definition as Kit et al. so that our results are comparable. The mean calorie consumption and percentage of total daily calories consumed from sugar-sweetened beverages among U.S. adults declined from 196 kcal and 8.7% in 1999–2000 to 151 kcal and 6.9% per day in 2009–2010. For youth the drop has been more dramatic. The mean calorie consumption and the percentage of calories consumed from sugar-sweetened beverages among U.S. youth declined from 223 kcal and 10.9% in 1999–2000 to 155 kcal and 8.0% per day in 2009–2010. Our reports found that in 2011–2014 U.S. adults consumed 145 kcal and 6.5% of their daily caloric intake from sugar-sweetened beverages, while U.S. youth consumed 143 kcal and 7.3%.
Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL. Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999–2010. Am J Clin Nutr 98(1):180–8. 2013.
Q: How many U.S. adults and children are consuming at least one sugar-sweetened beverage a day?
AR: Nearly half or 49.3% of U.S. adults and almost two-thirds or 62.9% of children are consuming at least one sugar-sweetened beverage a day. Using the 2011-2012 and 2013-2014 Alternative Population Control totals these percentages translate to more than 111 million U.S. adults and 47 million children who drank at least one sugar-sweetened beverage on a given day.
Q: Were there any findings that surprised you?
AR: We were surprised by the finding that non-Hispanic Asian adults and youth consumed fewer calories from sugar-sweetened beverages than any other race and Hispanic origin group. In fact, consumption in this group was nearly half the amount of calories and percent of total daily caloric intake than the other groups. For example, on average non-Hispanic Asian boys consumed 73 kilocalories from sugar-sweetened beverages representing 3.5% of their total daily caloric intake, whereas every other group consumed more than 150 kcals and more than 7% of their total caloric intake from sugar-sweetened beverages.
Questions for Michael Albert, Medical Officer and Lead Author on “Physician Office Visits for Attention-deficit/Hyperactivity Disorder in Children and Adolescents Aged 4–17 Years: United States, 2012–2013”
Q: Did we learn anything new from this new report about the problem of Attention-deficit/Hyperactivity Disorder (ADHD) among children?
MA: Yes, this report provides a snapshot of health care utilization related to ADHD among children aged 4-17 years. Specifically, it looks at visits to physician offices and uses nationally representative data from the 2012-13 National Ambulatory Medical Care Survey. Based on a sample of 946 visits by children aged 4-17 years with a primary diagnosis of ADHD, an estimated annual average of 6.1 million physician office visits were made by this age group during 2012-13, corresponding to a visit rate of 105 visits per 1,000 children.
Q: Does your research back up the notion that boys are more commonly afflicted with ADHD than girls?
MA: Our analysis did find that among children aged 4-17 years with a primary diagnosis of ADHD, the visit rate was more than twice as high for boys as girls.
Q: Is it true that medication is very often involved in the treatment of ADHD?
MA: Central nervous system stimulant medications were provided, prescribed, or continued at approximately 80% of these ADHD visits. A total of 29% of ADHD visits included a diagnostic code for an additional mental health disorder. In terms of what specialty of physician provided care at these visits, it was a pediatrician at 48%, psychiatrist at 36%, and general and family medicine physician at 12%.
Q: Was it surprising that 80% of office visits for ADHD involve medication?
MA: It is important to interpret this finding carefully. Because the National Ambulatory Medical Care Survey is a visit-based survey, as opposed to population based, estimates of persons cannot be made. Thus, the finding should not be interpreted as indicating that 80% of children aged 4-17 years with ADHD are taking CNS stimulant medications. It is possible that patients taking CNS stimulant medications tend to make more physician office visits than those not taking these medications. This might be in order to monitor the medication, or for other reasons such as differences in the severity of disease between those who take medication and those who do not. Although the use of medication in children with ADHD in our survey cannot be directly compared with population-based surveys, there is evidence from the latter that medication is frequently used. An analysis of parent-reported data from the National Survey of Children’s Health found that among children aged 4-17 years, 69% of children with current ADHD were taking medication for their ADHD (the specific medication was not identified).
Q: Anything else you’d like to address about the report?
MA: Again, we think the significance of this report lies in providing a snapshot of health care utilization related to ADHD in children that is nationally representative. We chose to investigate several variables to in our analysis that are of interest and provide important information.
During 2011–2014, 13.3% of children and adolescents aged 6–19 years had untreated dental caries in their permanent teeth.
The percentage of children and adolescents with untreated dental caries increased with age: 6.1% among those aged 6–11 years, 14.5% among those aged 12–15 years, and 22.6% among those aged 16–19 years.
Questions for Yahtyng Sheu, Senior Service Fellow and Lead Author on “Sports and Recreation Related Injury Episodes in the United States, 2011-2014”
Q: How many sports and recreation related injuries are being reported annually?
YS: According to our analysis, approximately 8.6 million of sports- and recreation- related injury episodes were reported annually among persons aged 5 and over using data from the 2011-2014 National Health Interview Survey. These injury episodes were medically-attended, for which a health care professional was contacted, either in person or by telephone, for advice or treatment. Therefore, these injury episodes were not limited to those resulted in emergency department visit or hospitalization.
Q: Did the sports and recreation related injuries differ by sex and age group? If so how?
YS: Yes. The distribution of sports- and recreation-related injuries differed by both sex and age. Approximately 60% of all the sports- and recreation-related injuries were sustained by men. Children and young adults between age 5 and 24 years old also accounted for 65% of the total sport- and recreation-related injuries.
Q: What types of sports and recreation activities are causing these injuries?
YS: Our data shows that general exercise, which includes aerobics, exercising, weight training, running, jogging, and school related activity, was the most frequently mentioned activity associated with sports-and recreation-related injuries. However, it does not mean that general exercise is more likely to “cause” injuries. We are unable to study what activities are more likely to cause injuries because the National Health Interview Survey do not collect data on activity participation. This prevents us from evaluating the risk of injury for individual activity.
Q: What parts of the body were more frequently injured while engaging in sports and recreation?
YS: Lower (42%) and upper (30%) extremities were the most frequently mentioned parts of body injured while engaging in the sports and recreation activity.
Q: Why did you decide to look at sports and recreation related injuries?
YS: Many epidemiological studies of sports- and recreation-related injuries have focused on specific populations, sport activities, or outcomes. Limited number of studies have provided national estimates on overall sports- and recreation-related injuries among all population. The latest national estimates on these type of injuries (that are not limited to emergency department visits data) were derived from 1997-1999 data. As more people engage in sports and recreation activity, we feel there is a need to address the patterns of sports- and recreation- related injuries using more recent data.
In 1999, the mortality rate for children and adolescents aged 10–14 years for deaths from motor vehicle traffic injury (4.5 per 100,000) was about four times higher than the rate for deaths for suicide and homicide (both at 1.2).
From 1999 to 2014, the death rate for motor vehicle traffic injury declined 58%, to 1.9 in 2014 (384 deaths).
From 1999 to 2007, the death rate for suicide fluctuated and then doubled from 2007 (0.9) to 2014 (2.1, 425 deaths).
The death rate for homicide gradually declined to 0.8 in 2014. In 2013 and 2014, the differences between death rates for motor vehicle traffic injury and suicide were not statistically significant.