Disease risk factors such as hypertension and high blood sugar rising

According to the study – done by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington – the world experienced a 49% increase in the number of global DALYs, or disability-adjusted life years (lost years of healthy life due to poor health and early death), attributable to metabolism-related risk factors between 2000 and 2021.

Researchers reported that poor health in people 15 to 49 years old was increasingly attributable to a high BMI and high FPG – also known as high blood sugar – that increases the risk of developing type 2 diabetes.

Other metabolic risk factors, such as high LDL cholesterol and SBP, landed in the top 10 risk factors for people in this age group.

“Though metabolic in nature, developing these risk factors can often be influenced by various lifestyle factors, especially among younger generations,” said Dr. Michael Brauer, an affiliate professor at IHME, in a statement. “They also are indicative of an aging population that is more likely to develop these conditions with time.”

“Targeting the reduction of preventable, non-communicable diseases through modifiable risk factors presents an enormous opportunity to pre-emptively alter the trajectory of global health through policy and education,” Brauer added.

The study authors said their analysis presents comprehensive estimates of the disease burden of 88 risk factors and their associated health outcomes for people for 204 countries and territories from 1990 to 2021.

They said the study incorporates IHME’s new burden of proof methodology for the first time, which “rigorously evaluates the evidence linking risk factors, diseases, and injuries, and offers an additional lens through which to prioritize actions and highlight areas in need of further research.”

Among the biggest contributors to DALYs in 2021 were particulate matter air pollution, smoking, and low birthweight and short gestation, with considerable variation across ages, sexes, and locations.

However, the researchers also said that substantial progress happened between 2000 to 2021 to reduce worldwide burden of disease attributable to risk factors linked to unsafe water, sanitation, maternal and child health, and household air pollution from cooking with solid fuels.

“Risk factors that currently lead to ill health, such as obesity and other components of metabolic syndrome, exposure to ambient particulate matter air pollution, and tobacco use, must be addressed via a combination of global health policy efforts and exposure reduction to mitigate health risks and improve population health,” said Dr. Emmanuela Gakidou, a professor of health metrics sciences at IHME, in a statement.

“With increasing exposure to risk factors such as high blood sugar, high blood pressure, low physical activity, and diet high in sugar-sweetened beverages — there is an urgent need for interventions focused on obesity and metabolic syndromes,” said Dr. Greg Roth, the director of the program in cardiovascular health metrics and an adjunct associate professor of health metrics sciences at IHME.

The researchers also said future trends may be quite different than past trends because of climate change and other factors such as increasing obesity and addiction.

“But, at the same time, there are tremendous opportunities to alter the trajectory of health in the next generation,” said Dr. Liane Ong, a lead research scientist at IHME.

The team said declines in disease burden for risk factors related to maternal and child health and unsafe water, sanitation, and handwashing were largely due to decreases in risk exposure but also to proportionally smaller infant and youth populations.

The authors said the improvements suggest public health measures and humanitarian health initiatives over the past three decades have succeded, with high rates of decline in risk factors in areas ranking lower on the socio-demographic Index, which measures income, fertility, and education.

There were also considerable declines in the global disease burden associated with child and maternal malnutrition risk factors, such as child growth failure. Age-standardized attributable DALY rates decreased by 71%, between 2000 and 2021. Low birthweight and short gestation rates decreased by 33% during the same period.

The study authors said that despite decreases at the global level, the disease burden attributable to risk factors related to child and maternal malnutrition remained high in super-regions of sub-Saharan Africa as well as areas of North Africa and the Middle East, South Asia, and parts of East Asia, Southeast Asia and Oceania.

Disease burden associated with unsafe water sources, bad sanitation, and no access to a handwashing facility (all top-25 risks) declined, with respective decreases of 66%, 69%, and 65%, in attributable age-standardized DALY rates.

However, the burden attributable to smoking (age-standardized risk-attributable DALYs) rose moderately, due to an aging population, even though people’s exposure to smoking declined.

The researchers said that could be explained by disease burden (age-standardized risk-attributable DALYs) from ambient particulate air pollution, high BMI, high FPG, and high SBP, which increased substantially as people’s exposure increased and populations aged.

Dr. Cheng-Han Chen, an interventional cardiologist and the medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California, told Medical News Today that the GBD highlights continuing lifestyle choices leading to worsening metabolic markers, which in turn will likely lead to worse clinical outcomes.

“While metabolic syndrome is a condition we are all too familiar with in the United States, it is concerning to see that lifestyle changes spreading throughout the world are now leading to wider prevalence of metabolic syndrome in areas less accustomed to this condition,” said Chen, who wasn’t involved in the research.

Chen added that it’s “imperative” we focus global health resources on addressing many of the modifiable metabolic risk factors

“Public health campaigns can promote the importance of such interventions as healthier eating and regular exercise,” he said. “If the trendline is not changed, we will be looking at a worsening global burden of cardiovascular and other metabolic diseases in the coming years.”

Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California, told Medical News Today the findings aren’t surprising.

“There have been other studies that have shown a global increase in obesity and the secondary health effects associated with obesity,” said Ali, who wasn’t involved in the research. “Why this is happening is multifactorial and a difficult problem to solve.”

Ali theorized there’s been a gradual shift from primarily farming and agriculture to more industrialized society, so people in general have become more sedentary. Also, as technology progresses, there is even less need to leave the house.

He also said there’s easier and cheaper access to highly processed, less healthy foods.

“There is little education about healthy eating and exercise, especially in the U.S., from an early age,” Ali said. “So, a way to intervene is to start early with education about diet and exercise, so as children get older they are more likely to choose healthier foods and stay active.

Ali said finding ways to reduce the cost of whole foods and minimally processed foods is another issue that needs addressing.

“These are difficult issues to address, and it will likely take many years to see any meaningful change in a positive direction,” Ali said.