Physicians' Academy for Cardiovascular Education

Today’s adult generations less healthy than predecessors

Literature - Hulsegge G, Susan H, Picavet J, et al - Eur J Prevent Cardiol 2013; DOI: 10.1177/2047487313485512.


Today’s adult generations are less healthy than their predecessors: Generation shifts in metabolic risk factors: the Doetinchem Cohort Study.


Hulsegge G, Susan H, Picavet J, et al.
Eur J Prevent Cardiol 2013; DOI: 10.1177/2047487313485512.
 

Background

In the year 2040, it is estimated that more than one in every four Europeans and more than one in every five North Americans will be 65 years or older.[1] The health of the elderly of the future is partly determined by their exposure to metabolic risk factors during their life course. Metabolic risk factors including obesity, hypertension, and dyslipidaemia substantially increase the risk of chronic and in particular cardiovascular disease (CVD),[2–6] which is the main cause of disability and death in most high-income countries.[3,7] Knowledge about risk profiles of today’s generations is essential since it determines the disease burden later in life.
Generation shifts in metabolic risk factors were evaluated in this cohort study, by describing changes within four 10-year generations of Dutch adults (n=6377) during 16 years of follow-up.
The principal risk factors measured were body weight, blood pressure, total cholesterol levels, and levels of high-density lipoprotein (HDL) cholesterol.
The subjects were stratified by sex and generation at baseline into ten-year age groups (20–29, 30–39, 40–49, and 50–59 years); the follow-up analyses aimed to determine whether one generation had a different risk profile from a generation born ten years earlier - called a "generation shift".
 

Main results

  • The prevalence of overweight, obesity, and hypertension increased with age in all generations
  • The more recently born generations had a higher prevalence of these risk factors than generations born ten years earlier (p<0.05)(for example, 40% of the males who were in their 30s at baseline were classified as overweight; 11 years later the prevalence of overweight among the second generation of men in their 30s had increased to 52% (a statistically significant generational shift)). (fig. 1)
  • In women, these unfavourable changes in weight were only evident between the most recently born generations, in which the prevalence of obesity doubled in just 10 years.
  • There were unfavourable (and statistically significant) generation shifts in hypertension in both sexes between every consecutive generation (except for the two most recently born generations of men).
  • Unfavourable generation shifts in diabetes were found between three of the four generations of men, but not of women.
  • No generation shifts were  identified for hypercholesterolaemia, although favourable shifts in HDL cholesterol were only observed between the oldest two generations.


Conclusion

Adult generations of today are less healthy than their counterparts of previous generations. The prevalence of metabolic risk factors and the lifelong exposure to them have increased and probably will continue to increase, with development of overweight-related diseases, such as diabetes and cardiovascular disease, as a consequence.

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References

  1. Kinsella K and He W. An aging world: 2008 international population reports, P95/09-1. Washington, DC: U.S. Government Printing Office, 2009.
  2. Mannino DM and Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007; 370:765–773.
  3. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367:1747–1757.
  4. Berry JD, Dyer A, Cai X, et al. Lifetime risks of cardiovascular disease. N Engl J Med 2012; 366: 321–329.
  5. Dudina A, Cooney MT, Bacquer DD, et al. Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators. Eur J Cardiovasc Prev Rehabil 2011; 18: 731–742.
  6. Kondo T, Osugi S, Shimokata K, et al. Metabolic syndrome and all-cause mortality, cardiac events, and cardiovascular events: a follow-up study in 25,471 young- and middle-aged Japanese men. Eur J Cardiovasc Prev Rehabil 2011; 18: 574–580.
  7. Rayner M, Allender S and Scarborough P. Cardiovascular disease in Europe. Eur J Cardiovasc Prev Rehabil 2009; 16(Suppl 2): S43–S47.
 
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