2.7% Live a Healthy Lifestyle? What Can You Do?

What is a healthy lifestyle according to this study?

Non smoker

Eating a healthy diet

Normal body fat percentage

Being active

What is the evidence this is helpful?

Using surrogate markers for cardiovascular disease they showed that certain behaviors made a difference. Clearly smoking was a major issue for lifestyle changes but 71/5% of those studied were non-smokers.

Only 9.6% of people had a healthy body fat, in spite of having others. This, however, had the greatest impact on those markers.  People with a healthy body fat ratio had lower blood pressure, better cholesterol and lipoprotein levels, and other markers.  Next up was being active.

37.9% consumed a healthy diet and 46.5% were active enough.

From their paper:

Only 2.7% (95% CI, 1.9%-3.4%) of all adults had all 4 healthy lifestyle characteristics. Participants with 3 or 4 compared with 0 healthy lifestyle characteristics had more favorable biomarker levels except for mean arterial blood pressure, fasting glucose, and hemoglobin A1c. Having at least 1 or 2 compared with 0 healthy lifestyle characteristics was favorably associated with C-reactive protein, WBCs, HDL-C, total cholesterol, and homocysteine. For HDL-C and total cholesterol, the strongest correlate was body fat percentage. For homocysteine, a healthy diet and not smoking were strong correlates; for WBCs, diet was not a strong correlate.

What Markers Did They Use?

The authors of the study used surrogate markers that are associated with a decrease in cardiovascular disease.  Most were measured by a blood test such as  C-reactive protein (CRP), white blood cells (WBCs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), total cholesterol to HDL-C ratio, fasting low-density lipoprotein cholesterol, fasting triglycerides, fasting glucose, fasting insulin, insulin resistance, hemoglobin A1c (HbA1c), and homocysteine. Blood pressure measurements were taken.

The flaw in using surrogate markers can be seen with how smoking had less of an impact, and yet from long-term studies we know that smoking has more of an impact on health than any of the other markers in the study.

What Can You Do?

Eating a healthy diet and being active are two things that lead to improved function. But losing body fat is more important. Weight loss surgery is only performed on 1% of all obese Americans and yet, based on this study it would have the greatest impact on the health of all.  That combined with eating better and physical activity is the best thing most Americans can do for themselves.

From the study:

Table 3Multivariable Regression Analysis (β [SE, P Value]) Examining the Independent Association for Each Healthy Lifestyle Characteristic (Independent Variable) and the Biological Parameters (Dependent Variable), NHANES 2003-2006 (N=4745)a, b
Biological/health markerUnstandardized coefficient (SE, P value)c
Nonsmoker vs smokerHealthy diet vs unhealthy dietSufficiently active vs notNormal body fat percentage vs not
MAP (mm Hg)0.82 (0.5, .11)−0.85 (0.4, .06)−1.33 (0.4, .002)−3.14 (0.5, <.001)
C-reactive protein (mg/L)0.04 (0.03, .20)−0.07 (0.03, .01)−0.16 (0.02, <.001)−0.16 (0.05, .01)
White blood cells (×1000 cells/μL)−0.85 (0.1, <.001)−0.24 (0.1, .009)−0.50 (0.1, <.001)−0.62 (0.1, <.001)
Total cholesterol (mg/dL)−3.5 (1.8, .05)−4.1 (1.4, .006)0.41 (1.2, .73)−16.3 (1.9, <.001)
HDL-C (mg/dL)0.30 (0.5, .55)−0.39 (0.6, .50)3.2 (0.6, <.001)11.6 (0.9, <.001)
Total cholesterol to HDL-C ratio−0.13 (0.1, .03)−0.1 (0.1, .12)−0.25 (0.1, <.001)−1.1 (0.04, <.001)
Fasting LDL-C (mg/dL)−1.2 (2.8, .67)−5.0 (2.1, .02)1.8 (1.6, .25)−15.8 (2.9, <.001)
Fasting triglycerides (mg/dL)−17.0 (9.2, .07)−0.16 (5.5, .97)−20.3 (7.2, .008)−51.8 (6.6, <.001)
Fasting glucose (mg/dL)0.60 (1.3, .63)0.86 (1.4, .55)−4.8 (1.3, <.001)−6.0 (1.5, <.001)
Insulin (μIU/mL)1.8 (0.6, .003)−1.1 (0.4, .01)−3.1 (0.6, <.001)−6.0 (0.4, <.001)
HOMA0.41 (0.1, .008)−0.08 (0.1, .53)−0.80 (0.2, <.001)−1.5 (0.1, <.001)
HbA1c (%)0.02 (0.02, .43)0.05 (0.02, .05)−0.14 (0.03, <.001)−0.08 (0.03, .01)
Homocysteine (μmol/L)−0.65 (0.2, <.001)−0.51 (0.1, <.001)−0.30 (0.1, .02)−0.17 (0.2, .36)

Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in US Adults
Loprinzi, Paul D. et al.
Mayo Clinic Proceedings , Volume 0 , Issue 0 ,


Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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