Less than 7 percent of the US adult population has good cardiometabolic health, a devastating health crisis requiring urgent action, according to research led by a team at the Friedman School of Nutrition Science and Policy at Tufts University in a pioneering perspective on cardiometabolic health trends and discrepancies published in Journal of the American College of Cardiology. Their team also included researchers from Tufts Medical Center.
Researchers assessed Americans on five components of health: levels of blood pressure, blood sugar, blood cholesterol, obesity (overweight and obesity), and the presence or absence of cardiovascular disease (heart attack, stroke, etc.). They found that only 6.8 percent of US adults had optimal levels of all five components as of 2017-2018. Among those five components, trends between 1999 and 2018 also worsened significantly for obesity and blood sugar . In 1999, 1 in 3 adults had optimal levels of obesity (not overweight or obese); that number dropped to 1 in 4 by 2018. Similarly, while 3 in 5 adults did not have diabetes or prediabetes in 1999, fewer than 4 in 10 adults were free of these conditions in 2018.
“These numbers are staggering. “It is deeply problematic that in the United States, one of the wealthiest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health,” said Megan O’Hearn, a postdoctoral fellow at the Friedman School and lead author of the study. “We need a complete overhaul of our health system, food system and built environment because this is a crisis for everyone, not just one section of the population.”
The study looked at a nationally representative sample of about 55,000 people aged 20 or older from 1999 to 2018 from the 10 most recent cycles of the National Health and Nutrition Examination Survey. The research team focused on optimal, intermediate, and poor levels of cardiometabolic health and its components, not just the presence or absence of disease. “We need to shift the conversation because disease is not the only problem,” O’Hearn said. “We don’t just want to get rid of disease. We want to achieve optimal health and well-being.”
The researchers also identified large health disparities between people of different genders, ages, races and ethnicities, and levels of education. For example, adults with less education were half as likely to have optimal cardiometabolic health compared to adults with more education, and Mexican Americans were one-third as likely to have optimal levels compared to non-Hispanic white adults. Additionally, between 1999 and 2018, while the percentage of adults with good cardiometabolic health increased modestly among non-Hispanic white Americans, it decreased for Mexican Americans, other Hispanics, non-Hispanic blacks, and adults of other races .
“This is really problematic. “Social determinants of health such as food and nutritional security, social and community context, economic stability, and structural racism place individuals of various educational levels, races, and ethnicities at increased risk of health problems,” said Dariush Mozaffarian, dean of the Friedman School and senior author. “This highlights the other important work being done at the Friedman School and Tufts University to better understand and address the root causes of nutrition and health disparities in the US and around the world.”
The study also assessed “intermediate” levels of health – not optimal but still not bad – including conditions such as pre-diabetes, pre-hypertension and obesity. “Much of the population is at a critical inflection point,” O’Hearn said. “Identifying these individuals and addressing their health conditions and lifestyles early is critical to reducing growing health burdens and health inequities.”
The consequences of poor health among US adults go beyond personal health. “Its impacts on national health care spending and the financial health of the entire economy are enormous,” O’Hearn said. “And these conditions are largely preventable. We have the public health and clinical interventions and policies to be able to address these issues.
Friedman School researchers are actively working on many such solutions, O’Hearn said, including Food is Medicine interventions (using good nutrition to prevent and treat disease); incentives and subsidies to make healthy food more affordable; educating consumers about healthy eating; and engaging the private sector to drive a healthier and more equitable food system. “There are many different avenues through which this can be done,” O’Hearn said. “We need a multi-sectoral approach and we need the political will and willingness to do it.”
“This is a health crisis we’ve been facing for some time,” O’Hearn said. “There is now a growing economic, social and ethical imperative to pay significantly more attention to this problem than it has previously received.”
Reference: O’Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and disparities in cardiometabolic health among US adults, 1999-2018. J. Am. Coll. Cardiol. 2022; 80 (2): 138-151. doi: 10.1016/j.jacc.2022.04.046.
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