Less than 7% of the US adult 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 pioneering perspective on cardiometabolic health trends and disparities published in the July 12 issue of the Journal of the American College of Cardiology. His team also included researchers from Tufts Medical Center.
The researchers evaluated Americans 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 American 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 adiposity and blood glucose. In 1999, 1 in 3 adults had optimal levels of adiposity (not overweight or obese); that number dropped to 1 in 4 in 2018. Also, 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 deeply troubling that in the United States, one of the world’s wealthiest nations, fewer than 1 in 15 adults is in optimal cardiometabolic health. 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.”
Meghan O’Hearn, PhD candidate, Friedman School and lead author of the study
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 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 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 researchers also identified large health disparities between people of different sexes, ages, races and ethnicities, and education 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 problematic. Social determinants of health, such as food and nutrition security, social and community context, economic stability, and structural racism put people of different educational levels, races, and ethnicities at higher risk of health problems,” Dariush said. Mozaffarian, dean of the Friedman School and lead 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 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 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.”
O’Hearn, M. et al. (2022). Trends and disparities in cardiometabolic health among American adults, 1999-2018. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2022.04.046.