Triage Your Health Efforts: The Good, The Bad & The Ugly

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Fri Jul 25, 2008 2:52 pm

I have often referred to these numbers and the importance of prioritizing our efforts. Here is some of the data and the information I have referred to.


The determination of priorities for action in an emergency; A process in which things are ranked in terms of importance or priority

The Good:

EPIC is a large study of diet and health having recruited over half a million (520,000) people in ten European countries: Denmark, France, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden and the United Kingdom.EPIC was designed to investigate the relationships between diet, nutritional status, lifestyle and environmental factors and the incidence of cancer and other chronic diseases.

Many studies have come out of this database but 2 important ones are..

1) They followed 25,663 Adults, Aged 45-79 Years Since 1993-2006

They found

- Eating 5 servings of fruit and vegetables a Day Gives You the Life Expectancy of Someone Three Years Younger.

- Not smoking turned the clock back by 4-5 years.

- Increasing exercise by a moderate amount takes up to three years off.

Following these three simple changes was the equivalent of adding 10 more healthy years to your life expectancy

Khaw KT, Bingham S, Welch A, Luben R, Wareham N, et al. (2001) Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition. Lancet 357: 657–663. Find this article online

Khaw KT, Jakes R, Bingham S, Welch A, Luben R, et al. (2006) Work and leisure time physical activity assessed using a simple, pragmatic, validated questionnaire and incident cardiovascular disease and all-cause mortality in men and women: The European Prospective Investigation into Cancer in Norfolk prospective population study. Int J Epidemiol 35: 1034–1043

2) In a separate study that came out about a year later, they added in alcohol intake and found if someone followed the three behaviors above and limited alcohol intake, it was the equivalent of adding up to 14 more healthy years to your life expectancy.

Khaw KT, Wareham N, Bingham S, Welch A, Luben R, et al. (2008) Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study . PLoS Med 5(1): e12 doi:10.1371/journal.pmed.0050012

In the WHO report,

'Preventing Chronic Diseases: A Vital Investment' 06/06/2005

They found that of the 35 million deaths from chronic disease each year, three most important modi?able risk factors are:

- unhealthy diet and excessive energy intake;
- physical inactivity;
- tobacco use.

And, that these 3 modifiable risk factors cause/lead to the intermediate risk factors of raised blood pressure, raised glucose levels, abnormal blood lipids (particularly low density lipoprotein-LDL cholesterol), and overweight (body mass index 25- 29.9 kg/m2) and obesity (body mass index > 30 kg/m2).

They Estimated that of the 3 most important modifiable risk factors,

-4.9 Mil Die As a Result of Tobacco Use,
-2.7 Mil Die As a Result of Low Fruit/Vegetable Intake,
-1.9 Mil Die As a Result of Physical Inactivity

Added together, these three simple lifestyle behaviors themselves account for over 40% of the lifestyle related premature deaths.

In addition, they estimated that

-2.6 million people die as a result of Excess Weight
-7.1 million people die as a result of raised blood pressure;
-4.4 million people die as a result of raised total cholesterol levels

These add up to almost 24 million deaths per year, which is 65% of the 35 million people who die prematurely from chronic diseases that can easily be prevented by a few simple lifestyle behaviors.

And, as the WHO says that the first 3 cause the second 3, then we can then also say that the first 3 simple lifestyle behaviors themselves could prevent over 65% of the premature death from chronic disease.

They also said, "the major causes of chronic diseases are known, and if these risk factors were eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented."

While these are worldwide figures, lets apply this to just the USA..

In The USA right now

652,000 die from heart disease
559000 die from cancers
143000 die from stoke
75000 die from diabetes

That equals 1,429,000

If we can prevent 80% of heart disease, stroke and diabetes and 40% of the cancer, we can prevent about 928,000 of the 1,429,000. Thats over 65%.

(NOTE: The WHO believes their figures are underestimates of the impact and the real impact would be much higher than just 65% And, these are minimums. What if we looked at 9-12 servings of fruits & veggies, a BMI of 18.5-22, exercising 30-60 minutes 5-6 days per week, and being smoke free?)

That is the good news.

Now, The bad news..

In their report the WHO identified 10 misunderstandings that were obstacles to changing these modifiable risk factors. A few were relevant

1) Chronic diseases are often viewed as primarily affecting old people.

One quarter of all chronic disease deaths occur in people under 60 years of age.

2) The solutions for chronic disease prevention and control are too expensive to be feasible for low and middle income countries (populations).

In reality, a full range of chronic disease interventions are very cost- effective for all regions of the world. Many of these solutions are also inexpensive to implement.

3) Half Truths and kernels of truth. In these cases, the kernels of truth are distorted to become sweeping statements that are not true. Because they are based on the truth, such half-truths are among the most ubiquitous and persistent misunderstandings. Two principal half-truths are refuted below.

“ My grandfather smoked and was overweight and he lived to 96”.

Answer: In any population, there will be a certain number of people who do not demonstrate the typical patterns seen in the vast majority. For chronic diseases, there are two major types: 1) people with many chronic disease risk factors, who nonetheless live a healthy and long life; 2) people with no or few chronic disease risk factors, who nonetheless develop chronic disease and/or die from complications at a young age.

These people undeniably exist, but they are rare. The vast majority of chronic disease can be traced back to the common risk factors, and can be prevented by eliminating these risks.

4) ”Everyone has to die of something"

Answer: Certainly everyone has to die of something, but death does not need to be slow, painful, or premature. Most chronic diseases do not result in sudden death. Rather, they are likely to cause people to become progressively ill and debilitated, especially if their illness is not managed correctly. Death is inevitable, but a life of protracted ill-health is not. Chronic disease prevention and control helps people to live longer and healthier lives.

And more of the "bad"

In 2005, a study was published in the Archives of Internal Medicine, looked at how many Americans actually engage in these healthy lifestyle factors that are known to prevent most of the chronic diseases we die from.

Healthy Lifestyle Characteristics Among Adults in the United States, 2000. ARCH INTERN MED/VOL 165, APR 25, 2005

The surveyed over 153,000 Adults, age range from 18 to 74, through the
Behavioral Risk Factor Surveillance System, of the CDC.

The four Healthy Lifestyle Characteristics (HLC) were

1) Healthy Weight defined as a BMI 18.5 to 25

2) consumed the minimum of 5 Fruits & Vegetables Per Day

3) Engaged in Regular Physical Activity, defined as 30 Minutes, 5x/week

4) Did Not Smoke

For each individual HLC, the numbers were,

Not smoking was about 76%, healthy weight was about 40%, engaging in adequate exercise was 23% as was consuming the minimum fruits and veggies (22%).

However, when you put all 4 together, only 3% (2.8%) of Adults Followed All 4 HLC's.

The highest subgroup (well educated, upper income) was 5%

This study confirms the above.

They monitored 42 847 men in the Health Professionals Follow-up Study, 40 to 75 years of age and free of disease in 1986 for the following 5 healthy characteristics.

- Not currently smoking
- Diet score top 40%
- Exercise ≥30 min/d
- BMI <25 kg/m2
- Moderate alcohol (5–30 g/d) or less

Only 32% practiced any two of the above
Only 28% practiced any three of the above
Only 14% practiced any four of the above


Only 4% practiced all 5 Healthy Lifestyle Characteristics

Circulation. 2006 Jul 11;114(2):160-7. Epub 2006 Jul 3.Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications.

As does this study, which also confirms the above.

They followed 84,129 women participating in the Nurses' Health Study, 30 to 55 years of age, from 1980-1994 for the following 5 healthy characteristics.

- Not currently smoking
- Diet score top 40%
- Exercise ≥30 min/d
- BMI <25 kg/m2
- Moderate alcohol (< 5g/d)

Only 12.7% practiced any three of the above
Only 7.2% practiced any four of the above


Only 3.1% practiced all 5 Healthy Lifestyle Characteristics

Socioeconomic status had no substantial effect on the estimates

Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22

That is the bad.

Now for the Ugly

In a article published in the NEJM in 2005,

Olshansky, Butler,, NEJM, March 17, 2005

The authors predicted that For The First Time in US History Average Adult Life Expectancy May Be Decreasing. And that Obesity May Shorten Average Life Spans More Than Accidents, Homicides and Suicides Combined

Their famous quote from the study was

“If the childhood obesity problem continues to grow at its current rate, the new generation could be the first in history to have a life expectancy less than its parents.”

In January of this year, a study came out confirming that this has already happened.

3141 Counties Grouped Into 2068 County Units (CU)

Ezzati M, Friedman AB, Kulkarni SC, Murray CJL (2008) The reversal of fortunes: Trends in county mortality and cross-county mortality disparities in the United States. Plos Med 5(4): e66. Doi:10. 1371/journal.pmed.0050066

The looked at 3141 Counties in the USA and Grouped then together Into 2068 of what they called, County Units (CU). They did this to even out populations in the counties groups and ratios of male to females

Between 1983 and 1999 Life Expectancies:
Declined Significantly In 11 CU For Males,
Declined Significantly In 180 CU For Females
Average Decline was 1.3 Yrs

Also, Life Expectancies
Declined In 48 Counties For Males
Declined In 783 Counties For Females
Average Decline Was .5 (Women) and .4 (Men)

This was most prevalent in the Deep South, Mississippi River, Appalachia, Midwest, Texas

The main reasons were Smoking, Poor Diet, Weight, Blood Pressure, & Inactivity.

We can prevent and/or stop about 70% of this by simply not smoking, being at a healthy weight, engaging in regular exercise and eating the minimum recommendations of fruits and veggies. Yet only about 3-4% of Americans do this.

Think about it. Especially in regard to prioritizing, or triaging, our efforts to improve our health and lifestyle behaviors.

What matters most is what matters most.

In Health
Last edited by JeffN on Sun Sep 27, 2009 10:49 am, edited 6 times in total.
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prioritizing our efforts

Postby Clary » Sun Jul 27, 2008 9:54 am

JeffN wrote: ...... I have often referred to these numbers and the importance of prioritizing our efforts. Here is some of the data and the information I have referred to....

...We can prevent and/or stop about 70% of this by simply not smoking, being at a healthy weight, engaging in regular exercise and eating the minimum recommendations of fruits and veggies. Yet only about 3-4% of Americans do this...

...Think about it. Especially in regard to prioritizing. or triaging, our efforts to improve our health and lifestyle behaviors.,

What matters most is what matters most.

In Health

Thank you for this reminder, Jeff, substantiated "by the numbers" of the importance of simple lifestyle changes/behaviors/choices that we each can choose to do, to add years to our lives and life to our years. --and how it is up to each of us to do those things, and that we CAN! I want to live long AND be healthy! :nod:

I am "only" 67 yo (on August 25th) , and I feel there is a whole lot of life left for me to participate in. I have 17 grandchildren, and now the great grandchildren are on the way, and I have words to write, and places to visit, and people to love.

I appreciate the enhanced/advanced education I have received from your contributions since your forum was added to this board. Thanks!
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Postby f1jim » Sun Aug 03, 2008 8:25 pm

Well said!!!!
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Postby JeffN » Sat Sep 06, 2008 7:21 am

This just came out further supporting the dramatic impact of the above 5 lifestyle behaviors on health and longevity.

Arch Intern Med. 2008 Feb 11;168(3):284-90.

Exceptional longevity in men: modifiable factors associated with survival and function to age 90 years. Yates LB, Djoussé L, Kurth T, Buring JE, Gaziano JM.

BACKGROUND: Prospective data on nongenetic determinants of exceptional longevity are limited, and information on long-lived men and their functional status is particularly sparse. We examined modifiable factors associated with a life span of 90 or more years and late-life function in men.

METHODS: In this prospective cohort study of 2357 healthy men (mean age, 72 years) within the Physicians' Health Study (1981-2006), biological and lifestyle factors and comorbid conditions were assessed by self-report with baseline and annual questionnaires. Mortality and incidence of major diseases were confirmed by medical record review. Late-life function was assessed 16 years after baseline by the Medical Outcomes Study 36-Item Short-Form Health Survey.

RESULTS: A total of 970 men (41%) survived to at least age 90 years. Smoking was associated with increased risk of mortality before age 90 years (hazard ratio [HR]; 2.10; 95% confidence interval [CI], 1.75-2.51), and similar associations were observed with diabetes (HR, 1.86; 95% CI, 1.52-2.26), obesity (HR, 1.44; 95% CI, 1.10-1.90), and hypertension (HR, 1.28; 95% CI, 1.15-1.43). Regular exercise was associated with a nearly 30% lower mortality risk (HR, 0.72; 95% CI, 0.62-0.83). The probability of a 90-year life span at age 70 years was 54% in the absence of smoking, diabetes, obesity, hypertension, or sedentary lifestyle. It ranged from 36% to 22% with 2 adverse factors and was negligible (4%) with 5. Compared with nonsurvivors, men with exceptional longevity had a healthier lifestyle (67% vs 53% had <or=1 adverse factor), had a lower incidence of chronic diseases, and were 3 to 5 years older at disease onset. They had better late-life physical function (mean +/- SD score [maximum 100], 73 +/- 23 vs 62 +/- 30; P < .001) and mental well-being (mean score, 84 +/- 14 vs 81 +/- 17; P = .03). More than 68% (vs 45%) rated their late-life health as excellent or very good, and less than 8% (vs 22%) reported fair or poor health (P < .001 for trend). Regular exercise was associated with significantly better-and smoking and overweight with significantly worse-late-life physical function. Smoking also was associated with a significant decrement in mental function.

CONCLUSION: Modifiable healthy behaviors during early elderly years, including smoking abstinence, weight management, blood pressure control, and regular exercise, are associated not only with enhanced life span in men but also with good health and function during older age.

PMID: 18268169
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Postby JeffN » Wed Sep 17, 2008 9:35 am

and one more, also from the Nurses Health database.

From Reuters...

Healthy living cuts premature death risk in half
Tue Sep 16, 2008 7:38pm EDT

CHICAGO (Reuters) - Women who heed common sense health messages about smoking, diet and exercise can cut their risk of premature death in half, U.S. researchers said on Tuesday.

Many studies look at the impact of just one lifestyle change on overall health, but researchers at Harvard University wanted to see the total impact of a healthy diet, regular exercise, a healthy weight and a lifetime without smoking.

Dr. Rob van Dam and a team from the Harvard School of Public Health and Brigham and Women's Hospital followed 80,000 nurses for more than two decades.

The women kept detailed records of their diet, physical activity, alcohol consumption, weight, smoking and disease history. Over the study period, 8,882 of the women died, including 1,790 from heart disease and 4,527 from cancer.

Some 28 percent of these deaths could have been avoided if the women had never smoked, the researchers said.

And 55 percent of the deaths could have been avoided if the women had never smoked and exercised regularly, eaten a healthy diet low in red meat and trans-fats and maintained a healthy weight, they said.

Smoking played the biggest role in causing premature death, and alcohol consumption played the smallest, they said.

They found women who drank up to one drink a day had a lower risk of heart disease than those who abstained from alcohol.

"These findings underscore the importance of intensifying both efforts to eradicate cigarette smoking and those aimed at improving diet and physical activity," van Dam and colleagues wrote in the British Medical Journal.

The Official Abstract...

BMJ 2008;337:a1440

Combined impact of lifestyle factors on mortality: prospective cohort study in US women

Objective To evaluate the impact of combination's of lifestyle factors on mortality in middle aged women.

Design Prospective cohort study.

Setting Nurses’ health study, United States.

Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980.

Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors (cigarette smoking, being overweight, taking little moderate to vigorous physical activity, no light to moderate alcohol intake, and low diet quality score).

Results 8882 deaths were documented, including 1790 from cardiovascular disease and 4527 from cancer. Each lifestyle factor independently and significantly predicted mortality. Relative risks for five compared with zero lifestyle risk factors were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality. Additionally considering alcohol intake did not substantially change this estimate.

Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower mortality in middle aged women. Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified.

While I am sure most of do not smoke, avoiding second hand smoke is almost as an important of an issue. In addition, achieving a healthy weight , maintaining an active lifestyle, and consuming a healthy diet (adequate fruits and vegetables) and avoiding or minimizing alcohol intake are extremely important.

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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby ETeSelle » Thu May 24, 2012 8:03 am

JeffN wrote:They followed 84,129 women participating in the Nurses' Health Study, 30 to 55 years of age, from 1980-1994 for the following 5 healthy characteristics.

- Not currently smoking
- Diet score top 40%
- Exercise ≥30 min/d
- BMI <25 kg/m2
- Moderate alcohol (< 5g/d)

Only 12.7% practiced any three of the above
Only 7.2% practiced any four of the above


Only 3.1% practiced all 5 Healthy Lifestyle Characteristics

I'm in the 3.1%! :) WHOO HOO!
Read my Star McDougaller Story and my Testimonial thread
Trust me on this: One day you'll wake up and realize that it no longer feels like "being strict." It just feels GOOD. :)
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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Fri May 27, 2016 5:45 am

Only 6% of Americans Engage in The 5 Health Behaviors That Can Prevent the Majority of Chronic Disease

I think the 6% is artificially elevated compared to the surveys of the last 20 years listed above. The reason is, I have never seen sleep included before, which they used to replace diet, which artificially raised the number meeting all 5 behaviors because about 64% met the requirement for sleep when usually only about 1% meet it for diet.

In Health

Clustering of Five Health-Related Behaviors for Chronic Disease Prevention Among Adults, United States, 2013. Prev Chronic Dis 2016;13:160054. DOI:

Five key health-related behaviors for chronic disease prevention are never smoking, getting regular physical activity, consuming no alcohol or only moderate amounts, maintaining a normal body weight, and obtaining daily sufficient sleep. The objective of this study was to estimate the clustering of these 5 health-related behaviors among adults aged 21 years or older in each state and the District of Columbia and to assess geographic variation in clustering.


We used data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) to assess the clustering of the 5 behaviors among 395,343 BRFSS respondents aged 21 years or older. The 5 behaviors were defined as currently not smoking cigarettes, meeting the aerobic physical activity recommendation, consuming no alcohol or only moderate amounts, maintaining a normal body mass index (BMI), and sleeping at least 7 hours per 24-hour period. Prevalence of having 4 or 5 of these behaviors, by state, was also examined.


Among US adults, 81.6% were current nonsmokers, 63.9% obtained 7 hours or more sleep per day, 63.1% reported moderate or no alcohol consumption, 50.4% met physical activity recommendations, and 32.5% had a normal BMI. Only 1.4% of respondents engaged in none of the 5 behaviors; 8.4%, 1 behavior; 24.3%, 2 behaviors; 35.4%, 3 behaviors; and 24.3%, 4 behaviors; only 6.3% reported engaging in all 5 behaviors. The highest prevalence of engaging in 4 or 5 behaviors was clustered in the Pacific and Rocky Mountain states. Lowest prevalence was in the southern states and along the Ohio River.


Additional efforts are needed to increase the proportion of the population that engages in all 5 health-related behaviors and to eliminate geographic variation. Collaborative efforts in health care systems, communities, work sites, and schools can promote all 5 behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged.

Mass Media Article

Few Americans engage in health behaviors that prevent chronic disease
Written by Honor Whiteman
Medical News Today

There are five key health behaviors that can reduce the risk of chronic diseases, according to researchers, but little more than 6 percent of Americans adhere to them.

And one more

The results of this study are not only very sad, they did not improve over the 30 years of the study.

Healthy Lifestyles Reduce the Incidence of Chronic Diseases and Dementia: Evidence from the Caerphilly Cohort Study. PLoS ONE 8(12): e81877. doi:10.1371/journal.pone.0081877 (2013) ... ne.0081877

The Caerphilly Cohort Study

- 2,235 men aged 45–59 years followed for 30 years

- Tracked 5 Healthy Lifestyle Behaviors

1) Smoking: not smoking, including ex-smokers;

2) BMI: body mass index 18 to under 25 Kg/m2;

3) Diet: 3 or more portions of fruit &/or veggies/day was accepted as ‘healthy’, together with < 30% of calories from fat;

4) Physical activity: walking 2 or more miles to work each day, or cycling ten or more miles to work each day,

5) Alcohol: three or fewer units per day

- Those following all 5 slashed the risk of developing diabetes by 70%, heart attack, stroke and dementia by 60% & cancer by 40%

- Only 1% followed all five of the behaviors

- Only 5% followed at least 4

- At baseline..... only fifteen men consumed five or more portions of fruit and/or vegetables daily, so the definition of this behaviour was reduced to three or more portions per day, and 18% of men satisfied this criterion.

- Only 429 (19%) followed three behaviors, 111 (5%) followed four or five behaviours and only two (0.1%) followed all five behaviours

- These numbers didn't change over 30 years

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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Sat Oct 21, 2017 7:45 am

Looks like we have a new name for Triage or what we might call, Lifestyle Medicine/Health Triage

This is why we have to not only learn the principles and guidelines but also how to apply them to our own unique situation. And when we struggle, why we may need the help of an experienced health care professional.

As Dr McDougall said in one of his recent newsletters

"In contrast, many popular healthcare "gurus" have had no formal education in the potentially life-threatening matters of your health. Almost as troubling are the credentialed healthcare/diet advisors who provide advice based solely on reading other people's research articles. The relevance of their guidance must be placed in the context that many of them haven't touched a patient since their primary dietetic or medical training."

In Health

Personalizing Medicine, Past Reductionism
David L. Katz, M.D., M.P.H.
Founder, True Health Initiative
10/20/2017 09:37 am ... 2ce4290cde

With science driven forward by the view through a microscope, I worry that we may personalize medicine while overlooking the person. Those famous blind men examining the elephant in its isolated parts are a precautionary tale about the liabilities of reductionism run amok.

I have a remedy in mind, and have coined the term “hierarchical personalization” to characterize it. In case it catches on, remember you heard it here first.

First, we cannot personalize care for genes and intestinal microbes, and leave out the person. So, the first tier of hierarchical personalization is holistic. I have the 6 key domains of importance to lifestyle medicine in mind: social connections and relationships; stress and mental health; sleep; toxic exposures (substances, chronic pain, harsh environments at work or home, etc.); physical activity; and dietary pattern. Fundamentally, we can’t hope to personalize care without knowing who a person is, in the context of their life.

Second, there is sequential personalization. This is how holistic care can go from platitude to method. Perhaps someone wants to improve their diet and lose weight- but they have severe chronic pain, or terrible insomnia, or a toxic marriage. Personalization means figuring out what actually needs attention first so that the wherewithal to address the next goal, and the next is cultivated. The ascent to vitality does not involve a helicopter ride; it is made step by step, up a spiral stair.
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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Mon Apr 30, 2018 11:44 am

It is now over 10 years since my first post on this topic in this forum (which comes from a much earlier newsletter of mine), and little to anything has changed.

Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population
Circulation. 2018;CIRCULATIONAHA.117.032047
Originally published April 30, 2018 ... 117.032047

Full PDF ... nload=true


Background—Americans have a shorter life expectancy compared with residents of almost all other high-income countries. We aim to estimate the impact of lifestyle factors on premature mortality and life expectancy in the US population.

Methods—Using data from the Nurses' Health Study (1980-2014; n=78 865) and the Health Professionals Follow-up Study (1986-2014, n=44 354), we defined 5 low-risk lifestyle factors as never smoking, body mass index of 18.5 to 24.9 kg/m2, ≥30 min/d of moderate to vigorous physical activity, moderate alcohol intake, and a high diet quality score (upper 40%), and estimated hazard ratios for the association of total lifestyle score (0-5 scale) with mortality. We used data from the NHANES (National Health and Nutrition Examination Surveys; 2013-2014) to estimate the distribution of the lifestyle score and the US Centers for Disease Control and Prevention WONDER database to derive the agespecific death rates of Americans. We applied the life table method to estimate life expectancy by levels of the lifestyle score.

Results—During up to 34 years of follow-up, we documented 42 167 deaths. The multivariable-adjusted hazard ratios for mortality in adults with 5 compared with zero low-risk factors were 0.26 (95% confidence interval [CI], 0.22-0.31) for all-cause mortality, 0.35 (95% CI, 0.27-0.45) for cancer mortality, and 0.18 (95% CI, 0.12-0.26) for cardiovascular disease mortality. The population-attributable risk of nonadherence to 5 low-risk factors was 60.7% (95% CI, 53.6-66.7) for all-cause mortality, 51.7% (95% CI, 37.1-62.9) for cancer mortality, and 71.7% (95% CI, 58.1-81.0) for cardiovascular disease mortality. We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3-29.8) for women and 25.5 years (95% CI, 24.7-26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3-44.9) for women and 37.6 years (95% CI, 35.8-39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8-16.2) longer among female Americans with 5 lowrisk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1-14.2).

Conclusions—Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.

Clinical Perspective What Is New?
• A comprehensive analysis of the impact of adopting low-risk lifestyle factors on life expectancy in the US population is lacking.
• Adherence to 5 low-risk lifestyle-related factors (never smoking, a healthy weight, regular physical activity, a healthy diet, and moderate alcohol consumption) could prolong life expectancy at age 50 years by 14.0 and 12.2 years for female and male US adults compared with individuals who adopted zero low-risk lifestyle factors.

What Are the Clinical Implications?
• Americans could narrow the life-expectancy gap between the United States and other industrialized countries by adopting a healthier lifestyle.
• Prevention should be a top priority for national health policy, and preventive care should be an indispensable part of the US healthcare system.

The five habits that can add more than a decade to your life
Major study calculates effect on lifespan of habits including healthy eating and not smoking
The Guardian
Ian Sample Science editor
Mon 30 Apr 2018 05.00 EDT

People who stick to five healthy habits in adulthood can add more than a decade to their lives, according to a major study into the impact behaviour has on lifespan.

Researchers at Harvard University used lifestyle questionnaires and medical records from 123,000 volunteers to understand how much longer people lived if they followed a healthy diet, controlled their weight, took regular exercise, drank in moderation and did not smoke.

When the scientists calculated average life expectancy, they noticed a dramatic effect from the healthy habits. Compared with people who adopted none of them, men and women who adhered to all five saw their life expectancy at 50 rise from 26 to 38 years and 29 to 43 years respectively, or an extra 12 years for men and 14 for women.

Read more... ... -your-life
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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Thu May 17, 2018 2:57 pm

Going from 8.5% To 5.9% is a 30% decline

In Health

Twenty‐Year Trends in the American Heart Association Cardiovascular Health Score and Impact on Subclinical and Clinical Cardiovascular Disease: The Framingham Offspring Study
Journal of the American Heart Association. 2018;7:e008741


Background Data on the temporal trends in ideal cardiovascular health (CVH) as well as on their association with subclinical/overt cardiovascular disease (CVD) and death are limited.

Methods and Results This study included 3460 participants attending ≥1 of 4 consecutive exams of the Framingham Heart Study (1991–2008, mean age 55.4 years, CVH score ranged 0–14). We created 4 groups describing changes in CVH score between examination cycles 5 and 8, using first and last exams attended (high‐high: starting CVH score ≥8, last score of ≥8, referent; high‐low: ≥8 start and ≤7 last; low‐high: ≤7 start and ≥8 last; and low‐low: ≤7 start and ≤7 last) and related them to subclinical CVD cross‐sectionally, and incident CVD and death. Fewer people have ideal CVH scores over the past 20 years (8.5% for 1991–1995, 5.9% for 2005–2008, P=0.002), because of decreases in those with ideal status of body mass index, blood glucose, and serum cholesterol levels (P<0.05 for all). The odds of subclinical disease and risk of CVD and death were higher for all compared with the high‐high group (428 CVD and 367 death events, median follow‐up 5.1 years, hazard ratios for CVD: 1.39, 1.73, 1.9 and death: 1.12, 1.57, 1.4 and odds ratios for subclinical disease: 1.61, 1.98, 2.86 for high‐low, low‐high, and low‐low, respectively).

Conclusions The decreased presence of ideal CVH scores over the past 20 years resulted in increasing odds of subclinical disease and risk of CVD and death, emphasizing the importance of maintaining ideal CVH over the life course.

Clinical Perspective

What Is New?

The decrease in the percentage of people with ideal cardiovascular health over the past 20 years, mostly because of decreases in the proportion of those with an ideal body mass index, blood pressure, blood glucose and serum cholesterol levels, was associated with higher odds of subclinical disease and risk of overt cardiovascular disease and all‐cause mortality.

What Are the Clinical Implications?

Acquiring and maintaining a healthy lifestyle early in adulthood may reduce the incidence of cardiovascular disease and decrease rates of cardiovascular disease morbidity and mortality which are related to high financial costs, therefore attention should be placed on public health policies and community‐based efforts targeting smoking cessation, weight control, and promoting healthier diets as cost‐effective strategies for promoting cardiovascular health, along with screening and controlling high levels of blood pressure, glucose, and lipids.
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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Fri May 10, 2019 10:45 am

Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination. Survey 2009–2016 ... .2018.0105

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.
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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Sat May 18, 2019 5:48 am

UK heart disease fatalities on the rise for first time in 50 years
Haroon Siddique
Sun 12 May 2019
The Guardian

The outlet said deaths from heart and circulatory diseases in under-75s totaled 42,384 in 2017—up from 41,042 just three years earlier. British Heart Foundation data found that between 2012 and 2017 CVD deaths in people under age 65 increased 4%, and in the same time frame premature death rates for CVD fell just 9%. The previous five-year period, they’d fallen 25%.

The BHF attributed the increase to a growing population of residents with heart disease and the wide reach of obesity and type 2 diabetes.

There has been an 18% increase in people diagnosed with diabetes during the past five years, with an estimated 920,000 people having undiagnosed type 2 diabetes. Almost 5 million people are estimated to have undiagnosed high blood pressure.

Read more... ... rise-in-uk ... n-50-years
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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Thu Dec 19, 2019 8:47 am

And keeps getting worse

Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity
December 19, 2019
N Engl J Med 2019; 381:2440-2450
DOI: 10.1056/NEJMsa1909301 ... Zl3l9iB54s

Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity.

We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup–specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993–1994 and 1999–2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes.

The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state.Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).

Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.)


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Re: Triage Your Health Efforts: The Good, The Bad & The Ugly

Postby JeffN » Mon Jun 01, 2020 12:08 pm

Healthy Behavior Adherence: The National Health and Nutrition Examination Survey, 2005–2016
Published:April 25, 2020


Leading public health institutions recommend participation in several evidence-based behaviors, including exercise, a healthy diet, and maintenance of a normal BMI while simultaneously avoiding cigarette smoking and excessive alcohol consumption. The investigators attempted to evaluate the collective adherence to these recommendations and population trends in these behaviors by evaluating nationally representative surveys over a period of 12 years.

In 2019, the data from 26,194 National Health and Examination Survey participants who provided answers to survey questions regarding diet, physical activity, and usage of cigarettes and alcohol were analyzed. BMI was obtained from the examination data. Adherence to each behavior and the constellation of all 5 behaviors was assessed and tracked over a 12-year timeframe.

The smoking rates ( p=0.01) and adherence to a healthy BMI declined over time ( p=0.03). The total percentage of subjects who participated in all 5 behaviors ranged from 4.4% to 6.3%, whereas subjects who performed 2 or fewer behaviors ranged from 45.4% to 48.3%. Greater education ( p<0.0001), higher SES ( p<0.0001), and being a female participant ( p<0.0001) predicted higher behavior scores.

Only 1 in 5 Americans engage in 4 or more healthy behaviors, whereas almost half of them participate in fewer than 3 healthy behaviors. Increased participation in numerous healthy behaviors can decrease premature mortality, decrease the burden of chronic diseases, improve life quality, and provide substantial economic benefits. A public health practice of targeting a constellation of behaviors as opposed to individual behaviors is needed.
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