Table 3. Description of Age-38 Clinical Indicators of Poor Physical Health.

Clinical Indicator	Description	Prevalence at Age 38
		Males	Females
Metabolic Abnormalities	We assessed metabolic abnormalities by measuring 5 clinical indicators: obesity, high density lipoprotein (HDL) cholesterol level, triglyceride level, blood pressure, and glycated hemoglobin concentration.
Obesity1	To determine obesity, we measured waist circumference (in centimeters). Study members were considered obese if their waist measurement was greater than 88 cm for women or greater than 102 cm for men.	16%,	25%
High-Density    Lipoprotein Level1	Study members were considered to have a low HDL cholesterol level if the value was 40mg/dL (1.04mmol/L) or lower for men and 50 mg/dL (1.3 mmol/L) or less for women.	26%,	25%
Triglyceride    Level1	Study members were considered to have an elevated triglyceride level if their reading was 2.26 mmol/l or greater.	50%,	14%
Blood Pressure1	Blood pressure (in millimeters of mercury) was assessed according to standard protocols (Perloff et al., 1993). Study members were considered to have high blood pressure if their systolic reading was 130 mm Hg or higher or if their diastolic reading was 85 mm Hg or higher.	38%,	16%
Glycated    Hemoglobin2	Glycated hemoglobin concentrations (expressed as a percentage of total hemoglobin) were measured by ion exchange high performance liquid chromatography (Variant II; Bio-Rad, Hercules, Calif) (coefficient of variation, 2.4%), a method certified by the US National Glycohemoglobin Standardization Program (NGSP) http://www.missouri.edu/~diabetes/ngsp.html). Study members were designated as having this health risk if their scores were greater than 5.7%, the cutoff for pre-diabetes.	23%,	14%
Cardiorespiratory Fitness	Maximum oxygen consumption adjusted for body weight (in milliliters per minute per kilogram) was assessed by measuring heart rate in response to a submaximal exercise test on a friction-braked cycle ergometer, and calculated by standard protocols. Sex-specific quintiles were formed. Following Blair et al. (Blair, et al., 1996), study members in the lowest quintile were considered to have this health risk.	20%,	20%
Pulmonary Function	Pulmonary function was assessed using a computerized spirometer and body plethysmograph ("Standardization of Spirometry - 1994 Update," 1995). Measurements of vital capacity were repeated to obtain at least three repeatable values (within 5%) followed by full-forced expiratory maneuvers to record the forced expiratory volume in 1s (FEV1): The post-bronchodilator FEV1/FVC ratio after 200 mg salbutamol is reported as the primary lung function measure because it is the most sensitive measure for assessing airway remodeling in a large cohort. Study members with an FEV1/FVC ratio below .70 were classified as having significant airflow limitation (Rabe et al., 2007).	9%,	5%
Periodontal Disease	Examinations were conducted in all 4 quadrants using calibrated dental examiners; three sites (mesiobuccal, buccal, and distolingual) per tooth were examined, and gingival recession (the distance in millimeters from the cementoenamel junction to the gingival margin) and probing depth (the distance from the probe tip to the gingival margin) were recorded using a PCP-2 probe. The combined attachment loss (CAL) for each site was computed by summing gingival recession and probing depth (third molars were not included). We report the presence of periodontal disease, defined as 1+ site(s) with 5 or more mm of combined attachment loss (Thomson, et al., 2006).	28%,	18%
Systemic Inflammation	Elevation in inflammation was assessed by assaying high-sensitivity C-Reactive Protein (hsCRP, mg/L). High-sensitivity C-reactive protein level is thought to be one of the most reliable measured indicators of vascular inflammation and has been recently endorsed as an adjunct to traditional risk factor screening for cardiovascular risk. hsCRP was measured on a Hitachi 917 analyzer (Roche Diagnostics, GmbH, D-68298, Mannheim, Germany) using a particle enhanced immunoturbidimetric assay. The CDC/AHA definition of high cardiovascular risk (hsCRP >3 mg/L) was adopted to identify our risk group (Pearson et al., 2003).	16%,	26%

¹Based on the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

²Based on the NGSP clinical advisory committee 2010 recommendation http://www.ngsp.org/cac2010.asp