Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016.
Metab Syndr Relat Disord. 2018 Nov 27. doi: 10.1089/met.2018.0105. [Epub ahead of print]
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Araújo J1, Cai J2, Stevens J1,3.
1 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
2 Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
Several guidelines for cardiometabolic risk factor identification and management have been released in recent years, but there are no estimates of current prevalence of metabolic health among adults in the United States. We estimated the proportion of American adults with optimal cardiometabolic health, using different guidelines.
Data from the National Health and Nutrition Examination Survey 2009-2016 were analyzed (n = 8721). Using the most recent guidelines, metabolic health was defined as having optimal levels of
waist circumference (WC <102/88 cm for men/women), (104 cm = 40 inches)
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"Those who stray beyond the state-mandated waistlines are required to attend counseling and support sessions. Local governments and companies that don't meet specific targets are fined, sometimes quite heavily."
only 3.2% are now overweight
glucose (fasting glucose <100 mg/dL and hemoglobin A1c <5.7%),
blood pressure (systolic <120 and diastolic <80 mmHg),
triglycerides (<150 mg/dL), and
high-density lipoprotein cholesterol (≥40/50 mg/dL for men/women),
and not taking any related medication.
Changing from ATP III (Adult Treatment Panel III) guidelines to more recent cut points decreased the proportion of metabolically healthy Americans from 19.9% (95% confidence interval [CI]: 18.3-21.5) to 12.2% (95% CI: 10.9-13.6). Dropping WC from the definition increased the percentage of adults with optimal metabolic health to 17.6%.
Characteristics associated with greater prevalence of metabolic health were female gender, youth, more education, never smoking, practicing vigorous physical activity, and low body mass index. Less than one-third of normal weight adults were metabolically healthy and the prevalence decreased to 8.0% and 0.5% in overweight and obese individuals, respectively.
Prevalence of metabolic health in American adults is alarmingly low, even in normal weight individuals. The large number of people not achieving optimal levels of risk factors, even in low-risk groups, has serious implications for public health.