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In the study of associated discrete variables, limitations on the range of the possible association measures (Pearson correlation, odds ratio, etc.) arise from the form of the joint probability function between the variables. These limitations are known as the Fréchet bounds. The bounds for cases involving associated binary variables are explored in the context of simulating datasets with a desired correlation and set of marginal probabilities. A new method for creating such datasets is compared to an existing method that uses the multivariate probit. A method for simulating associated binary variables using a desired odds ratio and known marginal probabilities is also presented. The Fréchet bounds for correlation between dependent binomial and negative binomial variables are determined as families of ranges in various cases. An example of a realistic analysis involving the Fréchet bounds in a dependent binomial setting is presented.

Sugar-Sweetened Beverages (SSBs) are liquids sweetened with various forms of added sugar. They are the leading source of calories and added sugar in the American diet (Drewnowski & Rehm, 2014; National Cancer Institute, 2016; Powell, Chriqui, Khan, Wada, & Chaloupka, 2013). The health and nutrition literature has increasingly identified added sugars and SSBs as a key potential contributor to a host of public health issues including obesity, type 2 diabetes, hypertension, and cardiovascular disease (Johnson et al., 2009; Malik, Popkin, Bray, Despres, & Hu, 2010; Vartanian, Schwartz, & Brownell, 2007). Concern about these public health crises has recently animated regional and local campaigns to attempt to limit consumption of these items through taxes and other policies. These policy proposals have raised demand for information and research about the drivers and effects SSB and beverage consumption in general. This study documents the major systems that have been used to categorize different types of SSBs and proposes a new beverage categorization typology – the Synthesized Beverage Categorization System – that cross references information from the What We Eat In America Food Categories and the Food Patterns Equivalents Database to offer the most precise SSB typology available today. The remaining sections use reported dietary intake data from the National Health and Nutrition Examination Survey (NHANES) to analyze consumption patterns of sugary beverage subtypes in a number of ways. First this study lays the groundwork for future studies of beverage consumption by examining consumption patterns of major SSB subtypes for adults and children by a number of variables commonly used in dietary intake analysis. Second, this article provides an analysis of sociodemographic trends in the consumption of several major sugary-beverage subtypes by age group, race and gender. Finally, consumption patterns of conventional and “non-traditional” SSBs are provided for the last 4 NHANES data collection cycles to analyze recent trends in reported intake of calories and added sugars from sugary beverages.

ABSTRACT THE RELATIONSHIP BETWEEN UNMETABOLIZED FOLIC ACID AND SERUM FOLATE CONCENTRATIONS AND CANCER RISK IN OLDER US ADULTS by Regine L. Baldauff Importance Several studies have reported an increase in serum and unmetabolized folic acid levels since the implementation of folic acid fortification (January 1, 1998). However, the literature published during the post-folic acid fortification period is controversial with regards to the safety and potential risk for cancer in non-target populations. Objective To study the association between unmetabolized folic acid and serum folate and cancer in older US adults. Design, Setting, and Participants This is a cross sectional study using data from National Health and Nutrition Examination Surveys. Among 700 participants with identified unmetabolized folic acid, 147 cases were reported a history of having cancer from 1999-2002. Within the 7,981 subjects who had a recorded value for serum folate from 1999-2008; 1,459 reported a history of all cancer. Among the 4,007 women who had a recorded value for serum folate between 1999-2008; 288 reported a history of breast cancer. Main Outcome Measures Associations of unmetabolized folic acid and serum folate with all cancer and breast cancer was evaluated using a multivariable logistic regression analysis controlling for demographic and dietary intakes. Results Men and women without unmetabolized folic acid were 0.7 times less likely to develop cancer. Those over the age of sixty with the highest concentration of serum folate were 1.4 times more likely to have cancer than participants with lower serum folate concentrations. Women over the age of sixty with the highest concentration of serum folate were 1.8 times more likely to have breast cancer compared to women with lower serum folate concentrations. Conclusions and Relevance The presence of unmetabolized folic acid and high serum folate concentrations were related to an increased prevalence of cancer. Further research is warranted to investigate the cause and effect relationship.

This Ph.D. dissertation presents results that shed light on whether there is an association between dietary intake and depressive disorder, feelings of sadness, or thoughts of death. This question is investigated in the context of a secondary data analysis using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Subjects in this study were identified as a subpopulation of the NHANES survey that completed the Composite International Diagnostic Interview questionnaire for major depression. The presence of depression may lead to a decline in dietary intake and nutritional status. Conversely, poor dietary intake may have a role in the etiology of depression. Specifically, depression is associated with lower plasma, erythrocyte, phospholipid, and adipose tissue omega-3 fatty acids. Little is known about the comprehensive dietary intake of those with depression or depressive symptoms. Initially, comparisons of the dietary profile between those with and without depression or depressive symptoms were investigated. Secondly, analysis was done to determine the relationship between dietary omega-3 fatty acids and depression or depressive symptoms. Lastly, to clarify the relationship between diet and depression, misreporting of dietary energy intake was evaluated.No significant differences in the dietary profile or nutritional biochemistries were found between the altered mood and normal mood groups. No significant differences were found in dietary omega-3 fatty acids between the depressed and non-depressed groups, even after adjusting for confounding variables. Misreporting of energy intake was not significantly associated with altered mood status and remained non-significant after adjusting for confounding variables. In both groups, a significant decreasing trend in the ratio of energy intake to estimated basal metabolic rate (EI:BMRest) was found as body mass index increased.Based on dietary intake alone, the relationship between depression and specific nutrients may not be apparent. Dietary intake among those with depression and depressive symptoms appears to be adequate, but adequacy may not be sufficient as a route for prevention or management of depression. Further investigation of diet and depression ought to measure diet, including nutrition supplements, and biochemical levels of nutrients from a broader age range of adults and children and those with comorbid illnesses.

Background Within the last century, Type 2 diabetes mellitus has become one of the major health concerns both in the US and globally. Overall prevalence and incidence of the disease within younger populations including adolescents and young adults has sharply increased since 1990 and is estimated to increase further if no actions are taken. It is estimated that 5.7 million people have a form of diabetes. Of the total estimated prevalence of T2DM, 25% of persons with diabetes are unaware they have the disease. This study aims to identify populations most at risk as well as to label important risk factors associated with the rise of T2DM within the young adult population. Objectives This study aimed to measure the prevalence of diagnosed and undiagnosed T2DM among different populations based on ethnicity, socioeconomic status, and weight classification among a representative sample of young adults within the United States. This study also aims to identify and quantify associated risk factors of T2DM among young adults, and address current preventative and treatment measures. Methods Six two-year samples of the National Health and Nutrition Examination Survey (NHANES) containing a total of 62,160 individuals were compiled into one dataset. Of these, 11,874 young adults aged 20-40 were selected into the study. Prevalence of diagnosed and undiagnosed T2DM was calculated for specific populations. The study also aimed to identify important risk factors through univariate and multivariate binomial logistic regression analysis. Results Among young adults aged 20-40, overall prevalence of T2DM was found to be 1.4% (CI: 1.2-1.6%). Of observed diabetes cases, an alarming 20.1% (N = 68) were categorized as undiagnosed. Significant increases in risk were observed within older age groups, overweight and obese weight categories, individuals living below poverty and within minority racial/ethnic groups. Weight, measured by both BMI (OR: 10.7; CI:5.88-19.44) and waist circumference (OR: 5.29; CI: 3.18-8.79), was identified as the most influential risk factor, and should be a main area of focus in development of interventions. Increases in activity levels, both at work and during leisure-time, were found to decrease one’s risk of having T2DM. Discussion Type 2 diabetes has become a major health concern within the past decades, and will continue to be an area of focus in the future. If current trends of diabetes among the young continue, significant burden will be placed on both health facilities as well as on the economy. Based on the findings from this study, further research should be place on prevention methods aimed at altering life-style behaviors such as diet and exercise early in one’s life. Based on the alarming prevalence of undiagnosed cases, continued research and support should also be place on access to care for minorities, especially persons of Latin American decent.

Polybrominated Diphenyl Ethers (PBDEs) are flame retardants widely used within the United States in various products such as plastics, electronics, textiles and furniture. With an increase in production and usage, PBDEs have recently emerged as a contaminant of concern. Due to their chemical structure, PBDEs have the propensity to bioaccumulate in mammals. In fact, elevated PBDE concentrations have been recorded in human breast milk. Due to the potential widespread exposure to PBDEs, this study investigates human blood concentrations of PBDEs generated through the 2003-2004 National Health and Nutrition Examination Survey. Through the use of statistical modeling, a comparison of mean PBDE concentrations in ng/g lipid is conducted based on age, gender and ethnicity. From a sample of 2337 individuals, the average blood concentration of PBDEs was approximately 81 ng/g lipid. The average PBDE concentration of males was significantly higher than females, using a 95% confidence level. In addition, PBDEs detected in human blood ranged approximately from 0.05 to 3676 ng/g lipid, with the highest concentrations found in black males. Also, a logistic regression analysis is conducted to determine whether an increase in background PBDE concentrations is a risk factor for obesity. Furthermore, the analyses of PBDEs are repeated for phthalates and polychlorinated Biphenyls for comparison. Finally, the measured concentrations of PBDEs are also compared to health outcome data known to show potential risk.

Prediabetes, a condition in which glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes, affects approximately 37% of adults in the United States and is a major public health concern. Extensive research has evaluated the association between physical activity (PA) and type 2 diabetes; however, few studies have examined the association between PA and prediabetes. Therefore, we evaluated the association between PA (including leisure time, occupational and total) and prediabetes status among adults, stratified by gender, using multinomial logistic regression models fit to serial cross-sectional 2007-2014 National Health and Nutrition Examination Survey data. After adjusting for age, race, body mass index, smoking status, family history of hypertension and education, results suggest that the association between leisure time [moderate PA: 0.98 (95% CI: 0.80–1.21); tertile 3: 1.05 (95% CI: 0.75–1.49)] and total PA [tertile 1: 1.15, (95% CI: 0.96–1.38); tertile 2: 1.00, (95% CI: 0.79–1.27); tertile 3: 0.96, (0.77–1.20)] and undiagnosed prediabetes and was not statistically significant among women. However, compared to women who engaged in no occupational PA, engaging in the highest tertile was statistically significantly associated with lower odds of undiagnosed prediabetes [tertile 3: 0.75, (95% CI: 0.58–0.97)]. Compared to men who engaged in no leisure time PA, men engaging in the highest tertile of leisure time PA had a statistically significant lower odds of undiagnosed prediabetes [Tertile 3: 0.79, ( 0.65–0.98)]. Compared to men who did not engage in any PA, men engaging in any PA did not have a statistically significant decrease in odds of undiagnosed prediabetes [tertile 1: 0.90, (0.71–1.16); Tertile 2: 0.93, (0.74–1.18); Tertile 3: 0.99, (0.80–1.21)]. Overall, our results show that for both men and women, there was a general lack of association between leisure-time, occupational, and total physical activity and prediabetes status in adjusted analyses.