Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016.
Level 4 - case-series / case-control
Cross-sectional survey analysis of nationally representative data
PubMed 30484738 · doi:10.1089/met.2018.0105
What was done
Researchers analyzed data from 8,721 US adults in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2016 to estimate the prevalence of optimal cardiometabolic health. Under recent guidelines, optimal health required meeting cut points for all five criteria without medication: waist circumference (<102 cm men, <88 cm women), glucose (fasting glucose <100 mg/dL and HbA1c <5.7%), blood pressure (<120/<80 mmHg), triglycerides (<150 mg/dL), and HDL cholesterol (≥40 mg/dL men, ≥50 mg/dL women).
What was found
Using current guidelines, only 12.2% (95% CI: 10.9–13.6%) of American adults had optimal metabolic health, down from 19.9% (95% CI: 18.3–21.5%) under older ATP III criteria. Removing waist circumference increased the proportion to 17.6%. Less than one-third of normal-weight individuals were metabolically healthy, while prevalence dropped to 8.0% in overweight and 0.5% in obese adults. Higher prevalence was associated with female sex, younger age, higher education, never smoking, vigorous physical activity, and lower BMI.
Why it matters
This study provides an updated national baseline showing that only about one in eight US adults meets optimal standards across major cardiometabolic risk factors, highlighting widespread metabolic dysfunction even among normal-weight individuals.
Limits
The cross-sectional design captures a single point in time and cannot evaluate longitudinal outcomes or trajectories. The strict definition required optimal levels across all five parameters simultaneously without medication, meaning borderline abnormalities in any single marker classified an individual as not metabolically healthy.
Cited by
- supports According to NHANES data from 2009 to 2016, only 12.2% of American adults were metabolically healthy across key markers including blood pressure, HDL, triglycerides, and fasting glucose.
- supports Fewer than one-third of normal-weight individuals in the US are metabolically healthy.