Araújo Joana, Cai Jianwen, Stevens June
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.
Metab Syndr Relat Disord. 2019 Feb;17(1):46-52. doi: 10.1089/met.2018.0105. Epub 2018 Nov 27.
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), 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.
近年来已发布了多项关于心血管代谢危险因素识别与管理的指南，但美国成年人当前的代谢健康患病率尚无相关估计。我们使用不同指南对美国成年人具备最佳心血管代谢健康状况的比例进行了估计。
对2009 - 2016年美国国家健康与营养检查调查的数据（n = 8721）进行分析。依据最新指南，代谢健康定义为腰围（男性<102厘米/女性<88厘米）、血糖（空腹血糖<100毫克/分升且糖化血红蛋白<5.7%）、血压（收缩压<120且舒张压<80毫米汞柱）、甘油三酯（<150毫克/分升）以及高密度脂蛋白胆固醇（男性≥40毫克/分升/女性≥50毫克/分升）处于最佳水平，且未服用任何相关药物。
从ATP III（成人治疗小组第三次报告）指南转变为更新的切点标准后，代谢健康的美国人比例从19.9%（95%置信区间[CI]：18.3 - 21.5）降至12.2%（95% CI：10.9 - 13.6）。从定义中去除腰围后，具备最佳代谢健康状况的成年人比例增至17.6%。与代谢健康患病率较高相关的特征包括女性、年轻、受教育程度更高、从不吸烟、进行剧烈体育活动以及低体重指数。体重正常的成年人中，代谢健康者不到三分之一，超重和肥胖个体中的患病率分别降至8.0%和0.5%。
美国成年人的代谢健康患病率低得惊人，即便在体重正常的个体中亦是如此。即便在低风险群体中，大量人群未达到危险因素的最佳水平，这对公共卫生具有严重影响。
