Researchers at Tufts University found that most American adults rate 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 has good cardiometabolic health. That’s according to a study led by a team from the Friedman School of Nutrition Science and Policy at Tufts University in a pioneering perspective on cardiometabolic health trends and disparities to be published in the July 12 issue of Journal of the American College of Cardiology. Their research team also included scientists from Tufts Medical Center.
“These numbers are surprising. It is deeply troubling that in the United States, one of the wealthiest countries in the world, fewer than 1 in 15 adults have optimal cardiometabolic health.” – Meghan O’Hearn
In the study, researchers assessed Americans on five components of health: levels of blood pressure, blood cholesterol, blood sugar, fat (overweight and obesity), and the presence or absence of cardiovascular disease (heart attack, stroke, etc. ) They found that only 6.8% of US adults had optimal levels of all five components as of 2017-2018. Among these five components, trends between 1999 and 2018 also worsened significantly for blood glucose and adiposity. In 1999, 1 in 3 adults had optimal fat levels (not overweight or obese), but by 2018, that number had 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 surprising. It is deeply troubling that in the United States, one of the wealthiest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health,” said Meghan O’Hearn, a PhD candidate at the Friedman School and lead author of the study. . “We need a complete overhaul of our health care 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 about 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 researchers focused on optimal, intermediate, and poor levels of cardiometabolic health and its components, rather than the presence or absence of disease. “We need to change the conversation because 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 genders, ages, races and ethnicities, and education levels. For example, adults with less education were half as likely to have optimal cardiometabolic health compared with adults with more education, and Mexican Americans were one-third as likely as non-Hispanic white adults to have optimal levels. Furthermore, between 1999 and 2018, while the proportion 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 .
“We don’t just want to be disease free. We want to achieve optimal health and wellness.” – Meghan O’Hearn
“This is really problematic. Social determinants of health such as food and nutrition security, social and community context, economic stability, and structural racism place individuals of various educational levels, races, and ethnicities at an increased risk of health problems,” said Dariush Mozaffarian, Friedman dean . School and senior author. “This highlights other important work happening across 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 assessed “intermediate” levels of health – not optimal but not yet poor – including conditions such as pre-diabetes, pre-hypertension and obesity. “A large portion of the population is at a critical tipping point,” O’Hearn said. “Identifying these individuals and addressing their health conditions and lifestyles early is critical to reducing the growing health care burden and health disparities.”
The consequences of poor health among American adults go beyond personal health. “Its impacts on national health care spending and the financial health of the entire economy are huge,” 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.”
Researchers at the Friedman School are actively working on many such solutions, O’Hearn said, including Food is Medicine interventions (using good food to help prevent and treat disease); incentives and subsidies to make healthy food more affordable; educating consumers about a healthy diet; and engaging the private sector to foster 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 desire to do it.”
“This is a health crisis 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 far more attention than it has received.”
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, 4 July 202, Journal of the American College of Cardiology.
Funding: NIH/National Heart, Lung, and Blood Institute