Less than 7% of the US adult population has good cardiometabolic health

Less than 7 percent of the adult U.S. population is in good cardiometabolic health, a devastating health crisis that requires urgent action, according to research led by a team from the Friedman School of Nutrition Science and Policy at Tufts University in a groundbreaking perspective on cardiometabolic health trends and inequalities published in the Journal of the American College of Cardiology† Their team also included researchers from Tufts Medical Center.

Researchers evaluated Americans on five health components: blood pressure, blood sugar, blood cholesterol, obesity (overweight and obesity), and presence or absence of cardiovascular disease (heart attack, stroke, etc.). They found that only 6.8 percent of American adults had optimal levels of all five components as of 2017-2018. Of these five components, the trends between 1999 and 2018 also deteriorated significantly for adiposity and blood glucose. In 1999, 1 in 3 adults had optimal levels for adiposity (not overweight or obese); that number dropped to 1 in 4 in 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 striking. It is very problematic that in the United States, one of the richest countries in the world, less than 1 in 15 adults has optimal cardiometabolic health,” said Meghan O’Hearn, a Friedman School doctoral student and lead author of the study. “We need a complete overhaul of our healthcare system, our food system and our built environment because this is a crisis for everyone, not just one segment of the population.”

The study looked at a nationally representative sample of approximately 55,000 people ages 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, rather than just the presence or absence of disease. “We need to shift the conversation, because illness 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 among people of different genders, ages, races and ethnicities, and educational levels. For example, lower-educated adults were half as likely to have optimal cardiometabolic health compared with higher-educated adults, and Mexican Americans had one-third the optimal levels compared with non-Hispanic white adults. In addition, between 1999 and 2018, while the percentage of adults in good cardiometabolic health increased modestly among non-Hispanic white Americans, it declined for Mexican American, other Hispanic, 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, put individuals of different 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 underway within the Friedman School and Tufts University to better understand and address the root causes of poor nutrition and health inequalities in the US and around the world.”

The study also assessed “average” health levels — not optimal but not yet bad — including conditions such as pre-diabetes, pre-hypertension and overweight. “Much of the population is at a critical inflection point,” O’Hearn said. “Identifying these individuals and addressing their health status and lifestyle early is critical to reducing the growing burden of care and health inequalities.”

The ramifications of the bleak health of American adults extend beyond personal health. “Its implications for national health spending and the financial health of the entire economy are enormous,” O’Hearn said. “And these conditions are largely preventable. We have public health and clinical interventions and policies 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 help prevent and treat disease); incentives and subsidies to make healthy food more affordable; consumer education about healthy nutrition; and private sector involvement to promote a healthier and fairer food system. “There are many different ways this can be done,” O’Hearn said. “We need a multi-sectoral approach and we need the political will and desire to do it.”

“This is a health crisis that we’ve been dealing with for a while,” O’Hearn said. “Now there is a growing economic, social and ethical need to give this issue significantly more attention than it has received.”

Reference: O’Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and differences in cardiometabolic health in US adults, 1999-2018. J. Ben. col. cardiols. 2022;80(2):138-151. doi: 10.1016/j.jacc.2022.04.046.

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