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Associations between life’s essential 8 and metabolic health among us adults: insights of NHANES from 2005 to 2018

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Abstract

Background

Metabolic unhealth (MUH) is closely associated with cardiovascular disease (CVD). Life’s Essential 8 (LE8), a recently updated cardiovascular health (CVH) assessment, has some overlapping indicators with MUH but is more comprehensive and complicated than MUH. Given the close relationship between them, it is important to compare these two measurements.

Methods

This population-based cross-sectional survey included 20- to 80-year-old individuals from 7 National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Based on the parameters provided by the American Heart Association, the LE8 score (which ranges from 0 to 100) was used to classify CVH into three categories: low (0–49), moderate (50–79), and high (80–100). The MUH status was evaluated by blood glucose, blood pressure, and blood lipids. The associations were assessed by multivariable regression analysis, subgroup analysis, restricted cubic spline models, and sensitivity analysis.

Results

A total of 22,582 participants were enrolled (median of age was 45 years old), among them, 11,127 were female (weighted percentage, 49%) and 16,595 were classified as MUH (weighted percentage, 73.5%). The weighted median LE8 scores of metabolic health (MH) and MUH individuals are 73.75 and 59.38, respectively. Higher LE8 scores were linked to lower risks of MUH (odds ratio [OR] for every 10 scores increase, 0.53; 95% CI 0.51–0.55), and a nonlinear dose–response relationship was seen after the adjustment of potential confounders. This negative correlation between LE8 scores, and MUH was strengthened among elderly population.

Conclusions

Higher LE8 and its subscales scores were inversely and nonlinearly linked with the lower presence of MUH. MUH is consistent with LE8 scores, which can be considered as an alternative indicator when it is difficult to collect the information of health behaviors.

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Data availability

The National Center for Health Statistics, part of the Centers for Disease Control and Prevention, makes the National Health and Nutrition Examination Survey dataset accessible to the general public at https://www.cdc.gov/nchs/nhanes/index.htm.

References

  1. Stefan N, Schulze MB (2023) Metabolic health and cardiometabolic risk clusters: implications for prediction, prevention, and treatment. Lancet Diabetes Endocrinol 11(6):426–440. https://doi.org/10.1016/S2213-8587(23)00086-4

    Article  CAS  PubMed  Google Scholar 

  2. Stefan N (2020) Causes, consequences, and treatment of metabolically unhealthy fat distribution. Lancet Diabetes Endocrinol 8(7):616–627. https://doi.org/10.1016/S2213-8587(20)30110-8

    Article  PubMed  Google Scholar 

  3. Guo W, Jia J, Zhan M et al (2023) Association of metabolically unhealthy non-obese and metabolically healthy obese individuals with arterial stiffness and 10-year cardiovascular disease risk: a cross-sectional study in Chinese adults. Nutr J 22(1):44. https://doi.org/10.1186/s12937-023-00870-9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang JS, Xia PF, Ma MN et al (2023) Trends in the prevalence of metabolically healthy obesity among us adults, 1999–2018. JAMA Netw Open 6(3):e232145. https://doi.org/10.1001/jamanetworkopen.2023.2145

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tsatsoulis A, Paschou SA (2020) Metabolically healthy obesity: criteria, epidemiology, controversies, and consequences. Curr Obes Rep 9(2):109–120. https://doi.org/10.1007/s13679-020-00375-0

    Article  PubMed  Google Scholar 

  6. Lloyd-Jones DM, Allen NB, Anderson CAM et al (2022) Life’s essential 8: updating and enhancing the American heart association’s construct of cardiovascular health: a presidential advisory from the American heart association. Circulation 146(5):e18–e43. https://doi.org/10.1161/CIR.0000000000001078

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wang X, Ma H, Li X et al (2023) Association of cardiovascular health with life expectancy free of cardiovascular disease, diabetes, cancer, and dementia in UK adults. JAMA Int Med 183(4):340–349. https://doi.org/10.1001/jamainternmed.2023.0015

    Article  Google Scholar 

  8. Yi J, Wang L, Guo X, Ren X (2023) Association of Life’s Essential 8 with all-cause and cardiovascular mortality among US adults: a prospective cohort study from the NHANES 2005–2014. Nutr Metab Cardiovasc Dis 33(6):1134–1143. https://doi.org/10.1016/j.numecd.2023.01.021

    Article  PubMed  Google Scholar 

  9. Jin C, Li J, Liu F et al (2023) Life’s essential 8 and 10-year and lifetime risk of atherosclerotic cardiovascular disease in China. Am J Prev Med 64(6):927–935. https://doi.org/10.1016/j.amepre.2023.01.009

    Article  PubMed  Google Scholar 

  10. Adair KE, Padgett RN, von Waaden N, Wilson RL, Bowden RG (2021) Metabolic health, obesity, and cardiovascular disease: 2015–2016 national health and nutrition examination survey. Am J Med Sci 361(2):244–252. https://doi.org/10.1016/j.amjms.2020.09.010

    Article  PubMed  Google Scholar 

  11. Akyea RK, Ntaios G, Doehner W (2023) Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: a nationwide population-based cohort study. J Cachexia Sarcopenia Muscle 14:2653. https://doi.org/10.1002/jcsm.13340

    Article  PubMed  PubMed Central  Google Scholar 

  12. Zhao M, Zhang N, Wang M et al (2023) Transitions in metabolic health and onset age of cardiovascular diseases. Am J Prev Med 65:1059. https://doi.org/10.1016/j.amepre.2023.06.002

    Article  PubMed  Google Scholar 

  13. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet (London, England) 370(9596):1453–1457. https://doi.org/10.1016/s0140-6736(07)61602-x

    Article  Google Scholar 

  14. Zhang Z, Chen L, Liu H et al (2022) Gene signature for the prediction of the trajectories of sepsis-induced acute kidney injury. Crit Care 26(1):398. https://doi.org/10.1186/s13054-022-04234-3

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhang Z, Gayle AA, Wang J, Zhang H, Cardinal-Fernandez P (2017) Comparing baseline characteristics between groups: an introduction to the CBCgrps package. Ann Transl Med 5(24):484. https://doi.org/10.21037/atm.2017.09.39

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hong Y, Chen L, Pan Q, Ge H, Xing L, Zhang Z (2021) Individualized Mechanical power-based ventilation strategy for acute respiratory failure formalized by finite mixture modeling and dynamic treatment regimen. EClinicalMedicine 36:100898. https://doi.org/10.1016/j.eclinm.2021.100898

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lloyd-Jones DM, Allen NB, Anderson CAM et al (2022) Life’s essential 8: updating and enhancing the American heart association’s construct of cardiovascular health: a presidential advisory from the American heart association. Circulation 146(5):e18–e43. https://doi.org/10.1161/cir.0000000000001078

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lloyd-Jones DM, Ning H, Labarthe D et al (2022) Status of cardiovascular health in US adults and children using the American Heart association’s New “Life’s Essential 8” metrics: prevalence estimates from the national health and nutrition examination survey (NHANES), 2013 through 2018. Circulation 146(11):822–835. https://doi.org/10.1161/circulationaha.122.060911

    Article  CAS  PubMed  Google Scholar 

  19. Krebs-Smith SM, Pannucci TE, Subar AF et al (2018) Update of the healthy eating index: HEI-2015. J Acad Nutr Diet 118(9):1591–1602. https://doi.org/10.1016/j.jand.2018.05.021

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vilar-Gomez E, Nephew LD, Vuppalanchi R et al (2022) High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population. Hepatology 75(6):1491–1506. https://doi.org/10.1002/hep.32207

    Article  PubMed  Google Scholar 

  21. Institute NC. Healthy Eating Index SAS Code. Accessed August 31, 2022. https://epi.grants.cancer.gov/hei/sas-code.html

  22. Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF (2018) Healthy weight and obesity prevention: JACC health promotion series. J Am Coll Cardiol 72(13):1506–1531. https://doi.org/10.1016/j.jacc.2018.08.1037

    Article  PubMed  Google Scholar 

  23. Ortega FB, Lavie CJ, Blair SN (2016) Obesity and cardiovascular disease. Circ Res 118(11):1752–1770. https://doi.org/10.1161/CIRCRESAHA.115.306883

    Article  CAS  PubMed  Google Scholar 

  24. Alberti KG, Eckel RH, Grundy SM et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation 120(16):1640–1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644

    Article  CAS  PubMed  Google Scholar 

  25. Maria A et al (2001) Expert panel on detection e, treatment of high blood cholesterol in A. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285(19):2486–97. https://doi.org/10.1001/jama.285.19.2486

    Article  Google Scholar 

  26. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ (2015) Prevalence of the metabolic syndrome in the United States, 2003–2012. JAMA 313(19):1973–1974. https://doi.org/10.1001/jama.2015.4260

    Article  CAS  PubMed  Google Scholar 

  27. Zhang Z (2016) Univariate description and bivariate statistical inference: the first step delving into data. Ann Transl Med 4(5):91. https://doi.org/10.21037/atm.2016.02.11

    Article  PubMed  PubMed Central  Google Scholar 

  28. Song Z, Gao M, Lv J et al (2022) Metabolically healthy obesity, transition to unhealthy phenotypes, and type 2 diabetes in 0.5 million Chinese adults: the China Kadoorie Biobank. Eur J Endocrinol 186(2):233–244. https://doi.org/10.1530/EJE-21-0743

    Article  CAS  PubMed  Google Scholar 

  29. Kouvari M, Nathan MDC, Tsiampalis T et al (2023) Metabolically healthy overweight and obesity, transition to metabolically unhealthy status and cognitive function: results from the framingham offspring study. Nutrients 15(5):1289. https://doi.org/10.3390/nu15051289

    Article  PubMed  PubMed Central  Google Scholar 

  30. Commodore-Mensah Y, Lazo M, Tang O et al (2021) High burden of subclinical and cardiovascular disease risk in adults with metabolically healthy obesity: the atherosclerosis risk in communities (ARIC) study. Diabetes Care 44(7):1657–1663. https://doi.org/10.2337/dc20-2227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Tanisawa K, Ito T, Kawakami R et al (2022) Association between dietary patterns and different metabolic phenotypes in Japanese adults: Waseda’s health study. Front Nutr 9:779967. https://doi.org/10.3389/fnut.2022.779967

    Article  PubMed  PubMed Central  Google Scholar 

  32. Petermann-Rocha F, Deo S, Celis-Morales C et al (2023) An opportunity for prevention: associations between the life’s essential 8 score and cardiovascular incidence using prospective data from UK biobank. Curr Probl Cardiol 48(4):101540. https://doi.org/10.1016/j.cpcardiol.2022.101540

    Article  PubMed  Google Scholar 

  33. Sun J, Li Y, Zhao M et al (2023) Association of the American heart association’s new “Life’s Essential 8” with all-cause and cardiovascular disease-specific mortality: prospective cohort study. BMC Med 21(1):116. https://doi.org/10.1186/s12916-023-02824-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Isiozor NM, Kunutsor SK, Voutilainen A, Laukkanen JA (2023) Life’s Essential 8 and the risk of cardiovascular disease death and all-cause mortality in Finnish men. Eur J Prev Cardiol 30(8):658–667. https://doi.org/10.1093/eurjpc/zwad040

    Article  PubMed  Google Scholar 

  35. Gao M, Lv J, Yu C et al (2020) Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: a cohort study. PLoS Med 17(10):e1003351. https://doi.org/10.1371/journal.pmed.1003351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wei Y, Wang J, Han X et al (2020) Metabolically healthy obesity increased diabetes incidence in a middle-aged and elderly Chinese population. Diabetes Metab Res Rev 36(1):e3202. https://doi.org/10.1002/dmrr.3202

    Article  CAS  PubMed  Google Scholar 

  37. Chen GC, Chai JC, Xing J et al (2022) Healthful eating patterns, serum metabolite profile and risk of diabetes in a population-based prospective study of US Hispanics/Latinos. Diabetologia 65(7):1133–1144. https://doi.org/10.1007/s00125-022-05690-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Barrea L, Verde L, Simancas-Racines D et al (2023) Adherence to the Mediterranean diet as a possible additional tool to be used for screening the metabolically unhealthy obesity (MUO) phenotype. J Transl Med 21(1):675. https://doi.org/10.1186/s12967-023-04546-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Wang R, Olier I, Ortega-Martorell S et al (2022) Association between metabolically healthy obesity and risk of atrial fibrillation: taking physical activity into consideration. Cardiovasc Diabetol 21(1):208. https://doi.org/10.1186/s12933-022-01644-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Klitgaard HB, Kilbak JH, Nozawa EA, Seidel AV, Magkos F (2020) Physiological and lifestyle traits of metabolic dysfunction in the absence of obesity. Curr Diab Rep 20(6):17. https://doi.org/10.1007/s11892-020-01302-2

    Article  CAS  PubMed  Google Scholar 

  41. Murlasits Z, Kupai K, Kneffel Z (2022) Role of physical activity and cardiorespiratory fitness in metabolically healthy obesity: a narrative review. BMJ Open Sport Exerc Med 8(4):e001458. https://doi.org/10.1136/bmjsem-2022-001458

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gomez-Zorita S, Queralt M, Vicente MA, Gonzalez M, Portillo MP (2021) Metabolically healthy obesity and metabolically obese normal weight: a review. J Physiol Biochem 77(1):175–189. https://doi.org/10.1007/s13105-020-00781-x

    Article  PubMed  Google Scholar 

  43. Samouda H, Ruiz-Castell M, Karimi M et al (2019) Metabolically healthy and unhealthy weight statuses, health issues and related costs: Findings from the 2013–2015 European health examination survey in Luxembourg. Diabetes Metab 45(2):140–151. https://doi.org/10.1016/j.diabet.2017.11.007

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank the National Health and Nutrition Examination Survey participants and staff and the National Center for Environmental Health for their valuable contributions.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article. This study was supported by the National Natural Science Foundation of China (U200410394), The Research and Innovation Team Project of the First Affiliated Hospital of Zhengzhou University (QNCXTD2023015) and 2021 Henan Province health young and middle-aged discipline leader training project.

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Author notes

  1. Tongyue Yang and Jiayi Yi have Co-first authors to this work.

Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

    Tongyue Yang, Mingwei Shao, Zhao Linlin, Jiao Wang, Fengjuan Huang, Feng Guo, Guijun Qin & Yanyan Zhao

  2. Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China

    Jiayi Yi

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  1. Tongyue Yang
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Contributions

YT performed conceptualization, data curation, formal analysis, and writing—original draft preparation; YY did data curation and formal analysis. Mingwei Shao presented conceptualization and writing—original draft preparation; LZ provided conceptualization, JW carried out data curation, FH prepared writing—review and editing, FG analyzed formal analysis, and GQ developed conceptualization, validation, and writing—review and editing; YZ approved conceptualization, supervision, writing—review and editing, and funding acquisition.

Corresponding author

Correspondence to Yanyan Zhao.

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The authors declare no conflicts of interest that pertain to this work.

Ethics approval

The National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC) carry out NHANES. The NHANES study protocol was evaluated and approved by the NCHS Research Ethics Review Committee. Written informed permission was signed by each participant.

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Yang, T., Yi, J., Shao, M. et al. Associations between life’s essential 8 and metabolic health among us adults: insights of NHANES from 2005 to 2018. Acta Diabetol (2024). https://doi.org/10.1007/s00592-024-02277-2

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