Objective To characterize the prevalence of metabolic syndrome (MetS), its five components and their pharmacological treatment in US adults by gender and race over time. Background MetS is a constellation of clinical risk factors for cardiovascular disease, stroke, kidney disease and type 2 diabetes mellitus. Methods Prevalence estimates were estimated in adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999–2010 (in 2-year survey waves). The biological thresholds, defined by the 2009 Joint Scientific Statement, were: (1) waist circumference ≥ 102 cm (males), and ≥ 88 cm (females) (2) fasting plasma glucose ≥100 mg/dl (3) blood pressure of ≥130/85 mm Hg (4) triglycerides ≥150 mg/dl (5) high-density lipoprotein-cholesterol (HDL-C) <40 mg/dl (males) and <50 mg/dl (females). Prescription drug use was estimated for lipid-modifying agents, anti-hypertensives, and anti-hyperglycemic medications. Results From 1999/2000 to 2009/10, the age-adjusted prevalence of MetS (based on biologic thresholds) decreased from 25.5% (95%CI: 22.5–28.6) to 22.9% (20.3–25.5). During this period, hypertriglyceridemia prevalence decreased (33.5% to 24.3%), as did elevated blood pressure (32.3% to 24.0%). The prevalence of hyperglycemia increased (12.9% to 19.9%), as did elevated waist circumference (45.4% to 56.1%). These trends varied considerably by gender and race/ethnicity groups. Decreases in elevated blood pressure, suboptimal triglycerides and HDL-C prevalence have corresponded with increases in anti-hypertensive and lipid-modifying drugs, respectively. Conclusion The increasing prevalence of abdominal obesity, particularly among females, highlights the urgency of addressing abdominal obesity as a healthcare priority. The use of therapies for MetS components aligns with favorable trends in their prevalence.

Empirical findings do not support recent compression of morbidity when morbidity is defined as major disease and mobility functioning loss.

Using historical data from 1,763 birth cohorts from 1800 to 1935 in 13 developed countries, we show that what is now seen as normal—a large excess of female life expectancy in adulthood—is a demographic phenomenon that emerged among people born in the late 1800s. We show that excess adult male mortality is clearly rooted in specific age groups, 50–70, and that the sex asymmetry emerged in cohorts born after 1880 when male:female mortality ratios increased by as much as 50% from a baseline of about 1.1. Heart disease is the main condition associated with increased excess male mortality for those born after 1900. We further show that smoking-attributable deaths account for about 30% of excess male mortality at ages 50–70 for cohorts born in 1900–1935. However, after accounting for smoking, substantial excess male mortality at ages 50–70 remained, particularly from cardiovascular disease. The greater male vulnerability to cardiovascular conditions emerged with the reduction in infectious mortality and changes in health-related behaviors.

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IMPORTANCE Cigarette smoking during pregnancy increases the risk of preterm birth, low birth weight, and infant mortality. OBJECTIVE To assess the probability of preterm birth among expectant mothers who smoked cigarettes before pregnancy and quit smoking at the start or during pregnancy. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed information provided on live birth certificates from 2011 through 2017 that were obtained from US states that implemented the 2003 revision of the US live birth certificate. In total, 25 233 503 expectant mothers who delivered live neonates and had known prepregnancy and trimester-specific cigarette smoking frequency were included in the analyses. EXPOSURES Cigarette smoking frequency (1-9, 10-19, and Ն20 cigarettes per day) 3 months prior to pregnancy and for each trimester during pregnancy. MAIN OUTCOMES AND MEASURES Cigarette smoking cessation throughout pregnancy, after the first trimester, after the second trimester, and during the third trimester irrespective of first and second trimester smoking. Probability of preterm birth (<37 weeks' gestation). RESULTS Of 25 233 503 expectant mothers who delivered live neonates between 2011 and 2017, the modal age at delivery was 25 to 29 years; 52.9% were non-Hispanic white, 23.6% were Hispanic, and 14.2% were non-Hispanic black women; 22 600 196 mothers did not smoke during the 3 months prior to pregnancy, and 2 633 307 smoked during the 3 months prior to pregnancy. The proportion of prepregnancy smokers who quit throughout pregnancy was 24.3% in 2011 and 24.6% in 2017. The proportion of prepregnancy smokers who quit during the third trimester was 39.5% in 2011 and 39.7% in 2017. High-frequency cigarette smoking often occurred among expectant mothers who smoked during pregnancy (eg, 46.9% of third-trimester smokers smoked Ն10 cigarettes per day in 2017). The probability of preterm birth decreased more the earlier smoking cessation occurred in pregnancy. For example, the probability of preterm birth was 9.8% (95% CI, 9.7%-10.0%) among 25to 29-year-old, non-Hispanic white, primigravida and primiparous expectant mothers (ie, pregnant for the first time and not yet delivered) who smoked 1 to 9 cigarettes per day prior to pregnancy and maintained this frequency throughout their pregnancy. The probability of preterm birth was 9.0% (95% CI, 8.8%-9.1%) if smoking cessation occurred at the start of the second trimester (an 8.9% relative decrease), and 7.8% (95% CI, 7.7%-8.0%) if cessation occurred at the start of pregnancy (a 20.3% relative decrease). CONCLUSIONS AND RELEVANCE Quitting smoking-and quitting early in pregnancy-was associated with reduced risk of preterm birth even for high-frequency cigarette smokers.