US adults get failing grade in healthy lifestyle behavior

In this study, researchers from Oregon State University and the University of Mississippi examined how many adults succeed in four general barometers that could help define healthy behavior: a good diet, moderate exercise, a recommended body fat percentage and being a non-smoker. It's the basic health advice, in other words, that doctors often give to millions of patients all over the world.

Such characteristics are associated with a lower risk of cardiovascular disease as well as many other health problems, such as cancer and type 2 diabetes.

"The behavior standards we were measuring for were pretty reasonable, not super high," said Ellen Smit, senior author on the study and an associate professor in the OSU College of Public Health and Human Sciences. "We weren't looking for marathon runners."

From the perspective of public health, the findings of the research were not encouraging, Smit said.

"This is pretty low, to have so few people maintaining what we would consider a healthy lifestyle," she said. "This is sort of mind boggling. There's clearly a lot of room for improvement."

Part of the value of this study, the researchers said, is that the results are based on a large study group, 4,745 people from the National Health and Nutrition Examination Survey. It also included several measured behaviors, rather than just relying on self-reported information.

Measurements of activity were done with an accelerometer, a device people wore to determine their actual level of movement, with a goal of 150 minutes of moderate-to-vigorous activity a week. Blood samples were done to verify a person was a non-smoker. Body fat was measured with sophisticated X-ray absorptiometry, not just a crude measurement based on weight and height. A healthy diet was defined in this study as being in about the top 40 percent of people who ate foods recommended by the USDA.

The lifestyle characteristics were then compared to "biomarkers" of cardiovascular health. Some are familiar, such as blood pressure, cholesterol and glucose levels. Others are more sophisticated, such as C-reactive protein, fasting triglycerides, homocysteine and other data that can provide evidence of cardiovascular risk.

Many people, of course, accomplished one or more of the four basic lifestyle goals, such as not smoking or being adequately active. The most striking finding was how few people accomplished all the goals.

"I would expect that the more healthy lifestyles you have, the better your cardiovascular biomarkers will look," Smit said.

Indeed, the researchers found that having three or four healthy lifestyles, compared to none, generally was associated with better cardiovascular risk biomarkers, such as lower serum cholesterol and homocysteine levels. Having at least one or two healthy lifestyle characteristics, compared to none, was also associated with better levels of some cardiovascular risk biomarkers.

Among the other findings of the research:

• Although having more than one healthy lifestyle behavior is important, specific health characteristics may be most important for particular cardiovascular disease risk factors.
• For healthy levels of HDL and total cholesterol, the strongest correlation was with normal body fat percentage.
• A total of 71 percent of adults did not smoke, 38 percent ate a healthy diet, 10 percent had a normal body fat percentage, and 46 percent were sufficiently active.
• Only 2.7 percent of all adults had all four healthy lifestyle characteristics, while16 percent had three, 37 percent had two, 34 percent had one, and 11 percent had none.
• Women were more likely to not smoke and eat a healthy diet, but less likely to be sufficiently active.
• Mexican American adults were more likely to eat a healthy diet than non-Hispanic white or black adults.
• Adults 60 years and older had fewer healthy characteristics than adults ages 20-39, yet were more likely to not smoke and consume a healthy diet, and less likely to be sufficiently active.

More research is needed, experts say, to identify ways to increase the adoption of multiple healthy lifestyle characteristics among adults.