We’re in Worse Health Than We Thought: Less Than 7% of Adults Have Good Cardiometabolic Health

Tufts University researchers found that the majority of US adults score poorly on five components of heart and metabolic health, with clear racial disparities.

Scientists have uncovered a devastating health crisis that requires urgent action: Less than 7% of the US adult population is in good cardiometabolic health. That’s according to a study led by a team from Tufts University’s Friedman School of Nutrition Science and Policy in a groundbreaking perspective on cardiometabolic health trends and disparities to be published in the July 12 issue of the Journal of the American College of Cardiology. His research team also included scientists from Tufts Medical Center.

In the study, researchers evaluated Americans on five components of health: blood pressure levels, blood cholesterol, blood sugar, adiposity (overweight and obesity), and the presence or absence of cardiovascular disease (heart attack, stroke, stroke, etc). They found that only 6.8% of US adults had optimal levels of all five components in 2017-2018. Among these five components, the trends between 1999 and 2018 also got significantly worse for blood glucose and adiposity. In 1999, 1 in 3 adults had optimal levels of adiposity (not overweight or obese), but by 2018, that number dropped to 1 in 4. Similarly, while 60% of adults did not have diabetes or prediabetes in 1999, less than 40% of adults were free of these conditions in 2018.

“These numbers are amazing. It is deeply troubling that in the United States, one of the world’s wealthiest nations, fewer than 1 in 15 adults are in optimal cardiometabolic health,” said Meghan O’Hearn, a Ph.D. candidate 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 segment of the population.”

The study looked at a nationally representative sample of approximately 55,000 people age 20 and older between 1999 and 2018 from the 10 most recent cycles of the National Health and Nutrition Examination Survey. The researchers 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 change the conversation, because the disease is not the only problem,” O’Hearn said. “We don’t just want to be disease-free. We want to achieve optimal health and wellness.”

The team also identified large health disparities between people of different sexes, ages, races and ethnicities, and educational levels. For example, adults with less education were half as likely to have optimal cardiometabolic health compared to adults with more education, and Mexican Americans had one-third of optimal levels compared to non-Hispanic white adults. Furthermore, between 1999 and 2018, while the percentage of adults in good cardiometabolic health increased modestly among non-Hispanic white Americans, it decreased among Mexican Americans, other Hispanics, non-Hispanic blacks, and adults of other races.

“This is really troublesome. Social determinants of health, such as food and nutritional security, social and community context, economic stability, and structural racism put people of different educational levels, races, and ethnicities at higher risk for health problems,” he said. Dariush Mozaffarian, Dean of Friedman. School and main author. “This highlights the other important work being done at the Friedman School and Tufts University to better understand and address the underlying causes of poor nutrition and health disparities in the US and around the world.”

The study also looked at “intermediate” levels of health, not optimal but not yet poor, including conditions such as prediabetes, prehypertension and being overweight. “A large part of the population is at a critical tipping point,” O’Hearn said. “Identifying these people and addressing their health and lifestyle conditions early is critical to reducing growing health care burdens and health disparities.”

The consequences of the serious health condition of American adults go beyond personal health. “Its impact on national health care spending and the financial health of the entire economy is enormous,” O’Hearn said. “And these conditions are largely preventable. We have the clinical and public health interventions and policies in place to be able to address these issues.”

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 affordable; consumer education on a healthy diet; and the participation of the private sector to promote a healthier and more equitable food system. “There are a lot of different avenues through which this can be done,” O’Hearn said. “We need a multisectoral 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. “There is now a growing economic, social and ethical imperative to give this problem much more attention than it has been receiving.”

Reference: “Trends and Disparities in Cardiometabolic Health Among US Adults, 1999-2018” by Meghan O’Hearn MS, Brianna N. Lauren MS, John B. Wong MD, David D. Kim PhD, and Dariush MozaffarianMD, DrPH, July 4, 2022, Journal of the American College of Cardiology.
DOI: 10.1016/j.jacc.2022.04.046

Funding: NIH/National Heart, Lung, and Blood Institute