Less than 7% of the U.S. adult population has good cardiometabolic health, a devastating health crisis that requires urgent action, according to research led by a team from Tufts University’s Friedman School of Nutrition Science and Policy in a pioneering perspective on cardiometabolic health trends and disparities published in Journal of the American College of Cardiology. Their team also included researchers from Tufts Medical Center.
Researchers rated Americans based on five components of health: blood pressure levels, blood sugar, blood cholesterol, adiposity (overweight and obesity), and the presence or absence of cardiovascular disease (heart attack, stroke, etc.). They found that only 6.8 percent of U.S. adults had optimal levels of all five components over 2017-2018. Among these five components, trends between 1999 and 2018 also worsened significantly for adiposity and blood sugar. In 1999, 1 in 3 adults had optimal levels of adiposity (no overweight or obesity); 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 amazing. It is deeply problematic that in the United States, one of the richest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health, “said Meghan O’Hearn, a PhD student at Friedman School and lead author of the study.” a complete overhaul of our health system, our food system and the built environment, because this is a crisis for everyone, not just a segment of the population. “
The study looked at a nationally representative sample of approximately 55,000 people aged 20 and over 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, rather than the mere presence or absence of disease. “We need to change the subject, because disease isn’t the only problem,” O’Hearn said. “We don’t just want to be disease free. We want to achieve optimal health and well-being ”.
The researchers also identified large health disparities between people of different sex, age, race and ethnicity, and educational levels. For example, adults with less education were half as likely to have optimal cardiometabolic health than adults with more education, and Mexican Americans were one-third as likely to have optimal levels of non-Hispanic white adults. Additionally, between 1999 and 2018, while the percentage of adults with good cardiometabolic health increased slightly among non-Hispanic American whites, it fell 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 nutrition security, social and community context, economic stability and structural racism put individuals of different educational levels, races and ethnicities at greater risk of health problems, “said Dariush Mozaffarian. Dean of the Friedman Scholastic and Senior Author. “This highlights the other important work underway at Friedman School and Tufts University to better understand and address the underlying causes of poor nutrition and health disparities in the United States and around the world. “.
The study also assessed “intermediate” levels of health – suboptimal but not yet poor – including conditions such as pre-diabetes, pre-hypertension and overweight. “A large part of the population is at a critical turning point,” O’Hearn said. “Identifying these individuals and addressing their health conditions and lifestyle early is key to reducing growing health burdens and health inequalities.”
The consequences of the dire state of health among US adults extend beyond personal health. “Its impacts on national health 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 problems. “
Friedman School researchers are actively working on many of these solutions, O’Hearn said, including Food is Medicine interventions (using good nutrition to help prevent and treat disease); incentives and subsidies to make healthy food more accessible; consumer education on a healthy diet; and the commitment of the private sector to lead 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 the desire to do so.”
“This is a health crisis that we’ve been dealing with for a while,” O’Hearn said. “There is now a growing economic, social and ethical imperative to give this issue far more attention than it is receiving.”
Reference: O’Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and disparities in cardiometabolic health among US adults, 1999-2018. Marmalade. coll. thistle. 2022; 80 (2): 138-151. doi: 10.1016 / j.jacc.2022.04.046.
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