Scientific Report of the 2015 Dietary Guidelines Advisory Committee

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Part D. Chapter 1: Food and Nutrient Intakes, and Health: Current Status and Trends - Continued

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Prevalence of Health Conditions and Trends

Preventable, diet- and lifestyle-related chronic diseases, including high blood pressure, CVD, type 2 diabetes, and certain cancers, contribute to the high and rising costs of U.S. health care. Adults with overweight or obesity frequently have co-morbid conditions and higher chronic disease risk profiles that contribute substantially to higher health care costs. These health problems are persistent in the population and pose major public health concerns. Increasing rates of overweight and obesity among American youth have resulted in rising rates of CVD risk factors, including borderline high blood pressure and diabetes, in this population. Health disparities in risk profiles and disease rates are evident across racial, ethnic, and income strata. In a new health care and public health vision, prevention of chronic diseases and other lifestyle-related health problems would become a major focus. Examining the status and trends in these health conditions provides a framework for discussing their relationship to dietary intake and lifestyle factors and can help in identifying evidence-based strategies for prevention.

Question 15: What is the current prevalence of overweight/obesity and distribution of body weight, BMI, and abdominal obesity in the U.S. population and in specific age, sex, racial/ethnic, and income groups? What are the trends in prevalence?

Source of evidence: Data analysis

Conclusion

The current rates of overweight and obesity are extremely high among children, adolescents, and adults. These high rates have persisted for more than 25 years.

Overall, 65 percent of adult females and 70 percent of adult males are overweight or obese, and rates are highest in adults ages 40 years and older. Rates of overweight and obesity in adults vary by age and race/ethnicity.

  • Overweight (excluding obesity) is most prevalent in those ages 40 years and older, and in Hispanic American adults.
  • Obesity is most prevalent in those 40 years of age or older and in African American adults. Obesity is least prevalent in adults with highest incomes (400+ percent the poverty threshold).

Abdominal obesity is present in U.S. adults of all ages, increases with age, and varies by sex and race/ethnicity.

  • Abdominal obesity rates are highest in individuals ages 60 years and older, and are higher in women than men at all ages.
  • In men, abdominal obesity rates are slightly higher among non-Hispanic whites than Mexican Americans or African Americans. In women, abdominal obesity rates are lower in non-Hispanic whites than in Mexican Americans or African Americans.

Nearly one in three youth (31 percent), ages 2 to 19 years, is now overweight (85th -94th percentile) or obese (95th percentile) and these rates vary by age and ethnicity.

  • In youth ages 2 to 19 years, obesity prevalence increases with age, and the age category with the highest prevalence is 12-19 year olds.
  • In youth ages 2 to 19 years, the race categories with the highest prevalence of obesity are African Americans and Hispanics.

Implications

The persistent high levels of overweight and obesity require urgent population- and individual-level strategies across multiple settings, including health care, communities, schools, worksites, and families.

Comprehensive lifestyle interventions and evidence-based dietary interventions for weight management in individuals and small groups should be developed and implemented by trained interventionists and professional nutrition service providers in healthcare settings as well as in community locations, including public health facilities and worksites.

Quality of care standards in health care settings should include the provision and impact of preventive nutrition services provided by multidisciplinary teams of trained interventionists, as appropriate, and nutrition professionals. Incentives should be offered to providers and systems to develop preventive services.

The public should be encouraged to monitor their body weight and engage with their health care providers at least annually to assess their body weight and BMI. As appropriate, providers should use evidence-based approaches aimed at achieving and maintaining healthy body weight. Health care providers should encourage achieving and maintaining a healthy weight through healthy eating and physical activity behaviors.

The persistent high rates of obesity across the lifespan show the limited impact of our efforts to date. Accelerating progress in reversing obesity trends will require a more targeted, comprehensive, and coordinated strategy and a renewed commitment and action for sustained, large-scale, integrated multi-sectoral and cross-sectoral collaborations. Government at local, state, and national levels, the health care system, schools, worksites, community organizations, businesses, and the food industry all have critical roles in developing creative and effective solutions.

Behavioral change at the individual level is important. However, policy interventions that make healthy dietary and activity choices easier, more routine, and affordable and that reduce unhealthy options are likely to achieve population-wide benefits.

Age-appropriate nutrition and food preparation education should be a mandatory part of primary and secondary school curricula.

Review of the Evidence

To reach these conclusions, the DGAC examined evidence from NHANES 2009-2012, and additional survey years including 1988-1994 to 2011-2012 for trends data. These data are available in summary NHANES data table format on the CDC website, in published peer-reviewed articles by CDC,72-74 and in analyses requested by the DGAC and provided by CDC/NCHS (see Appendix E-2.16: Body mass index, adults ages 20 years and older, NHANES 2009-2012 and Appendix E-2.17: Body mass index, children and adolescents ages 2-19 years, NHANES 2009-2012).

The prevalence rates of overweight and obesity among U.S. adults have been extremely high for the past 25 years and appear to be at record high levels in women and to have plateaued at near record high levels in men (Figure D1.53). In 2009-2012, combined rates of overweight and obesity in adult men, ages 20 years and older, were 72.6 percent (38.1 percent for overweight and 34.5 percent for obesity) and 64.8 percent (28.8 percent for overweight and 36 percent for obesity) in women (Table D1.19). Rates of overweight and obesity in adults vary by age and ethnicity and are most pronounced in adults ages 40 years and older and in Hispanic and African American adults (Table D1.19).

Overweight affects 29.5 percent of adults ages 20 to 39 years, 35.9 percent of adults ages 40 to 59 years, and 35.7 percent of adults ages 60 years and older, while obesity affects 31.5 percent of adults ages 20 to 39 years, 38 percent of those ages 40 to 59 years, and 37.5 percent of those ages 60 years and older (Table D1.19).

Overweight affects 31.7 percent of adult African American men and 24.5 percent of adult African American women, while obesity affects 37.9 percent of adult African American men and 57.5 percent of adult African American women. Among adult Hispanic men, overweight affects 41.5 percent and obesity affects 38.5 percent, and among adult Hispanic women, overweight affects 33.5 percent and obesity affects 43 percent (Table D1.19).

Obesity is least prevalent (about 31 percent) in adults ages 20 years and older with highest incomes (400 + percent the poverty threshold) in 2007-2010 (Table D1.20), while affecting 37.2 percent of those with incomes below 100 percent of the poverty threshold, 37.3 percent of those with incomes from 100 percent to 199 percent of the poverty threshold, and 36.8 percent of those with incomes from 200 percent to 399 percent of the poverty threshold (Table D1.20). Across all income strata, combined rates of overweight and obesity and particularly obesity rates have risen over the past 25 years.

Abdominal obesity, as measured by waist circumference (WC), and defined as WC more than 102 cm in men and more than 88 cm in women, is a risk factor for CVD and diabetes .6 Abdominal obesity is prevalent in U.S. adults of all ages and varies by age and sex. In 2011-2012, overall rates of abdominal obesity were about 54 percent in adults ages 20 years and older, with a prevalence of about 44 percent in adult men and 65 percent in adult women (Table D1.21). Data from the NHANES 2007-2008 survey shows that men ages 20 to 39 years have the lowest rates of abdominal obesity (28.5 percent) compared to men ages 40 to 59 years (49.4 percent) and those ages 60 years and older (60.4 percent) (Table D1.21). Women ages 60 years and older have the highest rates of abdominal obesity (73.8 percent) compared to women ages 40 to 59 and 20 to 39 years (65.5 percent and 51.3 percent, respectively). Data from the 2011-2012 survey show that the highest prevalence of abdominal obesity among men is in non-Hispanic white men (44.5 percent), followed by Mexican American men (43.2 percent) and African American men (41.5 percent), while the highest prevalence among women is in African American women (75.9 percent), followed by Mexican American (71.6 percent) and non-Hispanic white women (63.3 percent) (Table D1.21). For 2007-2010, the prevalence of abdominal obesity is very high in obese adults ages 18 years and older (97 percent), and overweight adults (57 percent), compared to normal/underweight adults (8 percent).75 Since 1999 rates of abdominal obesity have risen in all age and racial strata of both adult males and females (Table D1.21).

After increasing from the 1980s until about 2004, rates of overweight and obesity in children and adolescents ages 2 to 19 years have since remained at very high levels (Figure D1.54). A significant decrease in obesity among children ages 2 to 5 years old was observed in an analysis comparing the survey data from 2003-2004 (13.9 percent) to 2011-2012 (8.4 percent).74 However, it is not clear whether this comparison of only two time periods reflects an actual downward trend. Currently, 14.9 percent of boys ages 2 to 19 years are overweight (85th to 94th percentile) and 17.6 percent are obese (95th percentile and greater); rates in girls ages 2 to 19 years are 14.9 percent and 16.1 percent, respectively. Furthermore, rates of obesity in youth increase with age and vary by ethnicity, with obesity found in 22.1 percent of African American and 21.8 percent of Hispanic Americans ages 2 to 19 years (Table D1.22).

For additional details on this body of evidence, visit:

Question 16: What is the relative prevalence of metabolic and cardiovascular risk factors (i.e., blood pressure, blood lipids, and diabetes) by BMI/body weight/waist circumference (abdominal obesity) in the U.S. population and specific population groups?

Source of evidence: Data analysis

Conclusion

Approximately 50 percent of adults who are normal weight have at least one cardiometabolic risk factor. Approximately 70 percent of adults who are overweight and 75 percent of those who are obese have one or more cardiometabolic risk factors.

Rates of elevated blood pressure, adverse blood lipid profiles (i.e., low high density lipoprotein cholesterol [HDL-C], high low density lipoprotein choldesterol [LDL-C], and high triglycerides), and diabetes are highest in adults with elevated abdominal obesity (waist circumference greater than 102 cm in men, greater than 88 cm in women).

Ninety-three percent of the children with type 2 diabetes are ages 12 to 19 years and 90 percent of these children with type 2 diabetes are overweight or obese. In children with type 2 diabetes, the prevalence of obesity is higher in African Americans, followed by American Indians and Hispanics, compared to non-Hispanic whites or Asian Pacific Islander youth.

Dyslipidemia and rates of borderline high blood pressure vary by weight status in boys and girls; rates are particularly high in obese boys.

Nearly three-fourths of the overweight or obese populations have at least one cardiometabolic risk factor.

Implications

The rates of cardiometabolic risk factors in adult Americans are extremely high and reflect the high rates of population overweight and obesity. Many adults have personal health profiles in which multiple metabolic risk factors co-exist and substantially increase risks for coronary heart disease, hypertension and stroke, diabetes, and other obesity-related co-morbidities. These are the most costly health problems in the Nation today and they can be prevented or better managed with intensive, comprehensive, and evidence-based lifestyle interventions carried out by multidisciplinary teams of trained professionals or through medical nutrition therapy provided by registered dietitians or nutritionists (AHA/ACC/TOS).2 Program plans and interventions needed to confront the nation’s obesity epidemic and its devastating metabolic consequences. A shift in the healthcare paradigm toward prevention is critical. Nutrition and lifestyle services for obesity prevention and weight management should be expanded and integrated. As part of this approach, quality of care guidelines need to be revised to incentivize the provision of personalized lifestyle and nutrition interventions to combat obesity and obesity-related chronic diseases and their metabolic risk factors and co-morbidities. As emphasized in Part D. Chapter 3: Individual Diet and Physical Activity Behavior Change and Part D. Chapter 4: Food Environment and Settings, the most effective approach to preventing and treating overweight and obesity in our nation across the lifespan requires both individual and population-based, environmental strategies. Initiatives in health care and public health and other government sectors should be complemented with collaborative approaches in retail, educational, and social service and agricultural settings to make the long-term adoption of healthy nutrition and lifestyle behavior not only feasible but normative.

The high rates of overweight and obesity in youth and their concomitant cardiometabolic risk factors require early preventive interventions at individual and population levels. Evidence-based strategies in health and public health settings also should be implemented and complemented by environmental approaches across wide-ranging sectors to reverse these priority health problems.

Review of the Evidence

To reach these conclusions, the DGAC examined evidence from NHANES 2007-2010 and 2009-2012 data and SEARCH for Diabetes in Youth Study (SEARCH). These data were available in published peer-reviewed articles by CDC,76 or SEARCH77 authors and in analyses requested by the DGAC and provided by CDC/NCHS (see Appendix E-2.18: Total cholesterol and high density lipoprotein cholesterol (HDL), adults ages 20 years and older, NHANES 2009-2012, Appendix E-2.19: Low density lipoprotein cholesterol (LDL-C) and triglycerides, adults ages 20 years and older, NHANES 2009-2012, Appendix E-2.20: Prevalence of high blood pressure, adults ages 18 years and older, NHANES 2009-2012, Appendix E-2.21: Total diabetes, adults ages 20 years and older, NHANES 2009-2012, Appendix E-2.22: Total cholesterol, high density lipoprotein cholesterol (HDL), and non-HDL-cholesterol, children and adolescents ages 6–19 years, NHANES 2009-2012, Appendix E-2.23: Low density lipoprotein cholesterol (LDL-C) and triglycerides, adolescents ages 12-19 years, NHANES 2009-2012, Appendix E-2.24: Prevalence of high and borderline high blood pressure (BP), children and adolescents ages 8-17 years, NHANES 2009-2012).

In U.S. adults ages 18 years and older, weight status is related to prevalent CVD risk. About two-thirds (66.6 percent) of U.S. adults, including more than half (56.1 percent) of normal weight adults (BMI 18.5-<25 kg/m2), have one or more CVD risk factors (including type I and type II diabetes, hypertension, or dyslipidemia, or self-reported smoking) (Figure D1.55). About 70 percent (69.6 percent) of adults who are overweight (BMI 25-<30 kg/m2) have at least one or more CVD risk factors, making them candidates for preventive weight management interventions, according to expert guidelines established by the American College of Cardiology, American Heart Association, and The Obesity Society for preventative weight management (see Part D. Chapter 2: Dietary Patterns, Foods and Nutrients, and Health Outcomes). Furthermore, more than one-quarter (27.8 percent) have two or more CVD risk factors (Figure D1.55). About three-quarters (74.6 percent) of adults who are obese (BMI 30 kg/m2) have one or more CVD risk factors and about 39 percent have two or more CVD risk factors (Figure D1.55). Cardio-metabolic risk factors also are substantially more prevalent in adult men and women who have abdominal obesity (Table D1.23).

In terms of plasma lipids, the prevalence of low HDL-C (<40 mg/dl), high LDL-C (≥160 mg/dl), and high triglycerides (≥ 200 mg/dl) is highest in obese adults (ages 20 years and older) compared to normal weight adults (Table D1.23). Similar patterns are observed in those who are overweight compared to normal weight adults (Table D1.23). These lipid profiles also are highest in men with abdominal obesity (> 102 cm) or women (>88 cm). (Table D1.23). High total cholesterol (≥ 200 mg/dl), low HDL-C (<40 mg/dl), and high triglycerides (≥ 130 mg/dl) also are most prevalent in obese compared to overweight or normal weight children and adolescents (Table D1.24). There does not appear to be a difference in the prevalence of high LDL-C (≥ 130 mg/dl) by weight status in children and adolescents (Table D1.24).

In adults ages18 years and older, rates of elevated blood pressure (defined as having measured systolic pressure of at least 140 mm Hg or diastolic pressure of at least 90 mm Hg and/or taking antihypertensive medication) are highest with obesity (39.2 percent) compared to normal weight (20 percent) or overweight (26.4 percent). It is also highest in those with elevated waist circumferences (men > 102cm (37.2 percent vs 23.3 percent; and > 88 cm in women (32.9 percent vs 17.8 percent) (Table D1.23). Similar to adults, the rate of borderline high blood pressure (defined as a systolic or diastolic blood pressure ≥ 90th percentile but < 95th percentile or blood pressure levels ≥ 120/80 mm Hg) in youth ages 8 to 17 years was highest in with obesity (16.2 percent) compared to those who are normal weight (5.4 percent) or overweight (10.9 percent) (Table D1.25). Diabetes in adults ages 20 years and above also increases with body mass index from 5.5 percent in those who are of normal weight, to 9 percent in overweight and 20.3 percent in obese adults and is more prevalent in those with abdominal obesity (men > 102cm (19.6 percent vs 8.3 percent); and > 88 cm in women (13.9 percent vs 2.6 percent) (Table D1.23).

Data from 2001 to 2004 in children (ages 3 to 19 years) participating in the SEARCH for Diabetes in Youth Study (SEARCH) show that 93 percent of youth with type 2 diabetes are ages 12 to 19 years. The prevalence of obesity among youth with type 2 diabetes is 79.4 percent and an additional 10.4 percent are overweight (Table D1.26). The percentage of overweight among youth with type 2 diabetes is not significantly different than rates in U.S. youth who do not have type 2 diabetes.77 However, the prevalence of obesity among youth with type 2 diabetes (79.4 percent) is much higher than in U.S. youth without type 2 diabetes (16.9 percent) (Table D1.26). The prevalence of obesity in those with type 2 diabetes was higher in African Americans (91.1 percent), followed by American Indians (88 percent), and Hispanics (75 percent) in comparison to non-Hispanic white or Asian Pacific Islander youths (about 68 percent for each) (Table D1.26).

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Question 17: What are the current rates of nutrition-related health outcomes (i.e., incidence of and mortality from cancer [breast, lung, colorectal, prostate] and prevalence of CVD, high blood pressure, diabetes, bone health, congenital anomalies, neurological and psychological illness) in the overall U.S. population?

Source of evidence: Data analysis

Conclusion

Adults have high rates of nutrition-related chronic diseases, including high blood pressure, CVD, diabetes, and various forms of cancer. Children and adolescents also have nutrition-related chronic diseases, including borderline high blood pressure and type 2 diabetes. At all ages, rates of chronic disease risk are linked to overweight and obesity. The rates of these chronic diseases vary by race/ethnicity and income status. Prevalence of osteoporosis and of low bone mass increases with age, particularly in post-menopausal women. Among the less common health outcomes:

  • Nutrition-related neurological and psychological conditions are a growing concern.
  • Congenital anomalies are a relatively rare, but important pregnancy outcome.

Implications

Given the high rates of nutrition-related chronic diseases in the adult population and rising rates in youth, it is imperative to develop prevention policies and programs that target all age groups and address nutrition and lifestyle issues with evidence-based interventions that are appropriate for delivery in multiple settings.

Qualified professionals should deliver multidisciplinary interventions and medical nutrition therapies, as appropriate, that are effective in reducing nutrition-related chronic diseases.

More studies are needed to understand the complex etiology of congenital anomalies and neurological and psychological conditions, and factors that influence bone health as well as healthy outcomes of pregnancy so as to inform potential dietary choices by the U.S. population.

Review of the Evidence

To reach these conclusions, the DGAC examined evidence from NHANES 2007-2010 and 2009-2012 (see Appendix E-2.18: Total cholesterol and high density lipoprotein cholesterol (HDL), adults ages 20 years and older, NHANES 2009-2012, Appendix E-2.19: Low density lipoprotein cholesterol (LDL-C) and triglycerides, adults ages 20 years and older, NHANES 2009-2012, Appendix E-2.20: Prevalence of high blood pressure, adults ages 18 years and older, NHANES 2009-2012, Appendix E-2.21: Total diabetes, adults ages 20 years and older, NHANES 2009-2012, Appendix E-2.22: Total cholesterol, high density lipoprotein cholesterol (HDL), and non-HDL-cholesterol, children and adolescents ages 6-19 years, NHANES 2009-2012, Appendix E-2.23: Low density lipoprotein cholesterol (LDL-C) and triglycerides, adolescents ages 12-19 years, NHANES 2009-2012, Appendix E-2.24: Prevalence of high and borderline high blood pressure (BP), children and adolescents ages 8-17 years, NHANES 2009-2012), the National Health Interview Survey (NHIS) 2012,78 SEARCH for Diabetes in Youth Study,79 American Heart Association, 2014 report,6 and the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute.80 The DGAC also examined evidence from CDC’s population-based birth defects surveillance system,81 Alzheimer’s Association 2014 Facts and Figures,82 and published data by CDC authors.83 

Cardiovascular Diseases

Cardiovascular diseases, including coronary heart disease, hypertension, and stroke, affect an estimated 83.6 million (35.3 percent) men and women ages 20 years and older in the United States.6 CVD increases with age, meaning that about half of those with CVD, 42.2 million adults, are ages 60 years and older.6 Rates of coronary heart disease also vary by race/ethnicity and income. Coronary heart disease is most prevalent in Hispanics (7.8 percent of those reporting the disease) and Native Americans (including Alaskan natives 12.5 percent) adults.78 Stroke is most prevalent in Native Americans (4.3 percent of those reporting the disease) and African Americans (3.9 percent).78 Coronary heart disease rates are inversely related to income. Rates are about 9.8 percent and 7.7 percent in those with lower income (less than 100 percent of the poverty threshold and 100 to 199 percent, respectively) compared to those with higher income (200 percent and greater of the poverty threshold; 1.9 percent). Stroke also is more prevalent in those with incomes less than 100 percent of the poverty threshold (4.8 percent) and 100 to 199 percent of the poverty threshold (3.7 percent) compared to those with higher incomes (1.9 percent).78 

The prevalence of elevated blood pressure (measured systolic pressure of at least 140 mm Hg or diastolic pressure of at least 90 mm Hg and/or taking antihypertensive medication), in adults ages 18 years and older (29 percent) is similar in adult men (29.8 percent) and women (28.3 percent) and varies by age and race/ethnicity (Table D1.27). Rates of elevated blood pressure are highest in adults ages 60 years and older (66.3 percent), and African Americans (41.5 percent), relative to non-Hispanic whites (27.9 percent) or Hispanics (26.1 percent) (Table D1.27). A similar pattern is seen in youth ages 8 to 17 years, with borderline high blood pressure in 8.3 percent overall (Table D1.25). Boys (12 percent) are much more likely to have borderline high blood pressure than are girls (4.6 percent), as are those ages 13 to 17 years (12.4 percent) compared to those ages 8 to 12 years (3.8 percent), and African Americans (12.1 percent) compared to non-Hispanic whites (7.2 percent) and Hispanics (8.5 percent) (Table D1.25).

Diabetes

Total diabetes (type I plus type II) is the sum of self-reported diabetes and undiagnosed diabetes. Diagnosed diabetes was obtained by self-report and excludes women who reported having diabetes only during pregnancy. Undiagnosed diabetes was defined as fasting plasma glucose of at least 126 mg/dL or a hemoglobin A1C value of at least 6.5% and was not reported as a physician diagnosis. The prevalence of diabetes in U.S. adults, is 14 percent for men and 10.8 percent for women 20+ years of age (Table D1.27). Rates increase with age, to 26 percent for adults ages 60 years and older, and are higher in African Americans (18.4 percent) and Hispanics (19.3 percent) compared to non-Hispanic whites (9.8 percent) (Table D1.27). Between 2001 and 2009, rates of type 2 diabetes in children and adolescents ages 10 to 19 years increased 30.5 percent79 and the disease now affects about 1 in 2,000 youth (0.46 per 1000) (Table D1.28). In 2009, type 2 diabetes appeared to be more common in girls than boys (0.58, vs. 0.35 /1000 youth), in older adolescents (ages15 to 19 years; 0.68) compared to those ages 10 to 14 years (0.23), and in American Indian (1.2), African American (1.06), and Hispanic (0.79) youth compared to non-Hispanic Whites (0.17) (Table D1.28).

Nutrition-related Major Cancers

Breast cancer: Breast cancer represents approximately 14 percent of all new cancer cases and 6.8 percent of all cancer deaths in the United States. In 2011, an estimated 2,899,726 (2.9 million) women in the United States had a history of breast cancer. About 232,670 new cases of breast cancer and 40,000 deaths from this disease are estimated for 2014. Breast cancer is the third leading cause of cancer death in the U.S.80 84 New cases of breast cancer are highest in the middle age and older women (about 22, 25.5, and 21.3 percent of new cases occur in women ages 45 to 54, 55 to 64 and 65 to 74 years, respectively) (Table D1.29) and in non-Hispanic white women (128/100,000 women per year), followed by African American (122.8/100,000 women). The death rate from this disease is also highest among women ages 55 to 84 years old (ranges 20.6 percent to 21.7 percent of deaths) and African Americans (30.6 of death/100,000), followed by non-Hispanic white women (21.7/100,000) (Table D1.29).

Prostate cancer: Prostate cancer represents approximately 14 and 5 percent of all new cancer cases and all cancer death, respectively in U.S. men. In 2011, an estimated 2,707,821 (2.7 million) men had a history of prostate cancer. About 233,000 new cases of prostate cancer and 29,480 deaths from this disease are estimated for 2014. Prostate cancer is the fifth leading cause of cancer death in the United States.84 85  New cases of prostate cancer are most prevalent in older men (about 32.7, 36.3 and 16.8 percent of new cases in men ages 55 to 64, 65 to 74, and 75 to 84 years, respectively) (Table D1.29) and African American (223.9 of new cases/100,000 men). The death rate from this disease is highest among men ages 75 to 84 years old (36.8 percent of deaths) and African Americans (48.9/100,000) (Table D1.29).

Colorectal cancer: Colorectal cancer represents approximately 8.2 and 8.6 percent of all new cancer cases and all cancer death, respectively in the United States. In 2011, an estimated 1,162,426 (1.2M) adult men and women had a history of colorectal cancer. About 136,830 new cases of colorectal cancer and 50,310 deaths from this disease are estimated for 2014, respectively. Colorectal cancer is the second leading cause of cancer death in the United States.84 86  The incidence (new cases) of this cancer is more common in men than women and is more common in those older than age 55 years (highest frequency observed among those ages 65 to 74 years (23.9 percent) (Table D1.29) and in African Americans (62.3 and 47.5 new cases/100,000 persons in African American men and women, respectively). The death rate from this disease also is highest in people older than age 55 years old (highest frequency observed among those ages 75 to 84 years old (27.3 percent of deaths) and in African American (27.7, and 18.5 deaths/100,000 persons in men and women, respectively) (Table D1.29).

Lung and Bronchus cancer: Lung and bronchus cancer represents approximately 13.5 and 27.2 percent of all new cancer cases and all cancer deaths, respectively in the United States. In 2011, an estimated 402,326 people had a history of lung and bronchus cancer. About 224,210 new cases of lung and bronchus cancer and 159,260 deaths from this disease are estimated in 2014, respectively. This cancer is the first leading cause of cancer death in the United States.84 87 The incidence of lung and bronchus cancer is more common in men than women and is more common in those older than age 55 years (highest frequency observed among those ages 65 to 74 years (31.7 percent) in African American men (93 new cases/100,000 persons), and in white women (53.8/100,000 persons) (Table D1.29). The death rate from this disease also is higher in older people (highest frequency observed among those ages 65 to 84 years (about 30 percent of deaths) and in African American men (75.7 deaths/100,000 persons), and non-Hispanic white women (39.8/100,000 persons) (Table D1.29).

Bone Health

Approximately 10 million (10.3 percent) American adults ages 50 years and older were reported to have osteoporosis (defined as T-score ≤ -2.5 at either the femoral neck or the lumbar spine) and 43 million (44 percent) to have low bone mass (defined as T-scores between -1.0 and -2.5 at either skeletal site) in NHANES 2005-2010 (Table D1.30). A higher percent of women are affected by osteoporosis (15 percent) and low bone mass (51 percent) than men (about 4 percent and 35 percent, respectively). Osteoporosis increases with advancing age, occurring in about 35 percent in women ages 80 years and older compared to 26 percent in those ages 70 to 79 years old. The prevalence of low bone mass is similar in women ages 50 to 59 year and 80 years and older (ranges from 49 to 53 percent). Osteoporosis and low bone mass are more prevalent in Mexican American (20 percent, 48 percent) and non-Hispanic white (16 percent, 53 percent) relative to African American (8 percent, 36 percent) women (Table D1.30).

Congenital Anomalies

Each year, about 3 percent (one in every 33 babies) is born with spina bifida (without anencephaly); cleft lip (with and without cleft palate), or cleft palate (without cleft lip).88 The estimated national prevalence of spina bifida was 3.17 per 10,000 live births in 1999-2007.81 During this same time period, the prevalence of having a baby with spina bifida was reported to be more common in Native Americans/Alaska Natives (4.02/10,000 live birth), followed by Hispanics (3.8/10,000), non-Hispanic whites (3.09/10,000), African-Americans (2.73/10,000), and Asian/Pacific Islanders (1.2/10,000).81 The estimated national prevalence of cleft palate and cleft lip is 5.67 and 9.3 per 10,000 live birth, respectively.81 The prevalence of both of these congenital anomalies was highest in non-Hispanic Native Americans/Alaskan Natives (20/10,000 [cleft lip] and 6.5/10,000 [cleft palate]), and was lowest in African-Americans (6/10,000 [cleft lip] and 4.2/10,000 [cleft palate]).81 

Congenital heart defects affect about 40,000 births (about 1 percent of births) per year in the United States.89 The number of babies with congenital heart defects, especially those forms that are less severe (ventricular septal defects and atrial septal defects), is increasing compared to the total number of births, while the prevalence of other types has remained stable.89

Neurological and Psychological Conditions

There are numerous types of neurological and psychological conditions, and the DGAC focused only on depression and Alzheimer’s disease. The prevalence of depression was estimated at 8 percent for the U.S. population ages 12 years and older in the NHANES 2007-2010 survey.90 Depression is higher in females (10 percent) than in males (6 percent), and highest in those ages 40 to 59 years (12 percent women, 7 percent men).90 Depression also is reported to be higher in African Americans (8 percent), followed by Mexican-Americans (6.3 percent) and non-Hispanic whites (4.8 percent) (NHANES 2005-2006).91

In 2014, about 3.2 million women and 1.8 million men in the United States, ages 65 years and older are reported to be living with Alzheimer’s disease.82 This disease is most prevalent in those ages 75 to 84 years (44 percent of those with Alzheimer’s) and those ages 85 years and older (38 percent).82 About 63, 59, and 30 percent of those ages 85 years and older with Alzheimer’s disease are reported to be Hispanics (primarily Caribbean-American), African Americans, and non-Hispanic white adults, respectively.82 It has been projected that the number of people with Alzheimer’s disease will increase by about threefold from 4.8 million in 2010 to 13.7 million in 2050.92

For additional details on this body of evidence, visit:

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