Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018.
Level 4 - case-series / case-control
Repeated cross-sectional survey design (NHANES)
PubMed 35798448 · doi:10.1016/j.jacc.2022.04.046
What was done
Authors analyzed serial cross-sectional data from 55,081 U.S. adults in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. They assessed trends in optimal cardiometabolic health—defined across adiposity, blood glucose, blood lipids, blood pressure, and clinical cardiovascular disease (CVD)—overall and across demographic subgroups including age, sex, education, and race/ethnicity.
What was found
In 2017–2018, 6.8% (95% CI: 5.4%–8.1%) of U.S. adults had optimal cardiometabolic health, declining from 1999–2000 (P trend = 0.02). Between 1999–2000 and 2017–2018, optimal adiposity fell from 33.8% to 24.0% while poor adiposity increased from 47.7% to 61.9% (P trend < 0.001). Optimal blood glucose decreased from 59.4% to 36.9% while poor glucose rose from 8.6% to 13.7% (P trend < 0.001). Conversely, optimal blood lipids increased from 29.9% to 37.0% and poor lipids dropped from 28.3% to 14.7% (P trend < 0.001). By 2017–2018, prevalence of optimal cardiometabolic health was lower among adults with lower education (5.0% [95% CI: 2.8%–7.2%]) vs higher education (10.3% [95% CI: 7.6%–13.0%]) and among Mexican American (3.2% [95% CI: 1.4%–4.9%]) vs non-Hispanic White (8.4% [95% CI: 6.3%–10.4%]) adults.
Why it matters
This paper shows that fewer than 1 in 14 U.S. adults meet optimal cardiometabolic criteria, with worsening population trends driven by adiposity and glycemic deterioration alongside persistent sociodemographic disparities.
Limits
The repeated cross-sectional design precludes longitudinal within-individual tracking and causal inference. Specific biomarker threshold criteria defining optimal, intermediate, and poor categories are not specified in the abstract, and clinical CVD was likely subject to self-report error.
Cited by
- supports Only about 6% of American adults are metabolically healthy, meaning roughly 94% have at least one marker of metabolic syndrome.