This paper, written by lead author See: June Stevens, at the UNC Lineberger Comprehensive Cancer Center, is an analysis of 7 years of NHANES data (a United States’ commissioned annual survey of people’s health) and their likelihood of being in metabolic health.
Early Days, We Still only Define Metabolic Disease
As we learned a long time ago to stop framing health in terms of the absence of disease, we are not yet doing that for metabolic health, so the authors used these cutpoints in their analysis, based on the review of literature:
- Waist Circumference, < 102/88 cm in men/women
- Systolic Blood Pressure, < 120 mmHG
- Diastolic Blood Pressure, < 80 mmHG
- Glucose < 100 mg/dL
- HbA1c < 5.7%
- Triglycerides < 150 mg/dL
- HDL-C >= 40/50 mg/dL men/women
They also looked at taking medications for blood pressure, diabetes, and cholesterol.
Notably absent in the list above is LDL cholesterol, which is consistent with its limited utility in understanding overall metabolic health (see: Just Read: Challenging the role of LDL vs Insulin Resistance in predicting heart disease, via Kaiser Permanente data as an example of research describing this issue)
For a typical person in the health care system, the measures above would be easily obtainable on a regular physical exam. The issue is that
- many physicians do not put the numbers together in this way
- many physicians do not know what to advise in situations where the numbers aren’t good, because treatment is mostly diet, not medicines
I am in the 12 %, How I stay there
By these numbers, I am in the 12 %, and I am able to comfortably stay there, mostly through diet and exercise. The image at the top of this post shows a typical day for me diet wise, along with continuous glucose monitor readings.
This is my holiday meal profile, with barely a budge into the low triple digits on glucose after a meal
America is at risk and the problem is getting worse
Unfortunately, Americans are at risk and the problem is getting worse, as they mostly do not eat the diet that I’ve shared above.
According to this analysis, only 42 % of Americans have glucose under 100 mg/dL. The trend is getting worse:
And most are unaware of their condition
Weight and Metabolic Health are two different things
Many studies (and physicians) who use weight or weight loss as a measure of health are using older paradigms, as confirmed here (again):
Even when WC was excluded from the defini- tion, only one-third of the normal weight adults enjoyed optimal metabolic health.Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metab Syndr Relat Disord [Internet]. Mary Ann Liebert, Inc., publishers 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA; 2018 Nov 27 [cited 2018 Nov 29];met.2018.0105.
There are physicians all over the world working to change this trajectory
Here’s one example, as reported by CBC, The Canadian Clinicians for Therapeutic Nutrition
Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metab Syndr Relat Disord [Internet]. Mary Ann Liebert, Inc., publishers 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA; 2018 Nov 27 [cited 2018 Nov 29];met.2018.0105.
Conflicts of Interest in the research
None noted. No industry sponsorship
Conflicts of Interest by this post author
None, conflict free is the way to be. Check out my disclosures page for details.