Apr 20 • 11M

Waist-to-height ratio, metabolic health and MS

Healthcare professionals should be able to look you in the eye and say “I am with you all the way”. Do they?

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I am giving a talk this Friday on treating MS beyond NEIDA (no inflammatory disease activity) and I am contemplating what I need to focus the talk on.  I am considering making the talk about a healthy lifestyle, which is probably the most effective preventive health intervention we have. 

Study 1 below shows that you can increase your chances, by a factor of over 20, of a life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 by making ensuring you maintain 4 or 5 low-risk lifestyle factors; i.e. not smoking, staying trim, doing moderate to vigorous physical activity, keeping your alcohol intake moderate and eating a quality diet.

A second population-based study below provides evidence that a healthy lifestyle affects the proportion of your remaining life years spent with or without dementia. This study analysed data from participants in the Chicago Health and Aging Project. They combined five modifiable lifestyle factors— (1) diet, (2) late-life cognitive activities, (3) physical activities, (4) smoking and (5) alcohol consumption—in a very simple composite score ranging from 0 to 5, with higher scores indicating more healthy behaviours. Surprise, surprise, participants with healthier lifestyles had longer life expectancies and their extra years of life did not mean extra time living with Alzheimer’s dementia. 

These findings have important implications for the well-being of ageing populations and for pwMS, who I assume want to age as best they can. The development and implementation of intervention programmes to improve brain health in pwMS are surely a low-cost must-have for pwMS to maximise their chances of getting to old age with as healthy a brain as possible? 

Although it could be argued these studies are for the general population the messages regarding lifestyle are applicable to pwMS. All these lifestyle factors have been linked to MS outcomes. In short, everyone with MS should assess their lifestyle to see if they can change things to maximise their long-term outcome.  Another thing you can do is to ask your HCP to score themselves on these five factors. I maintain that HCPs have a responsibility to lead by example and they should be practising what they preach. HCPs should be able to look you in the eye and say “I am with you all the way”

What is not discussed in these papers is the fact that what determines your ability to live a ‘healthy life’ is often down to the social determinants of health (SDoH) and these are usually beyond the control of the individual. Lack of education, poverty, inequality, social isolation, a poor lived environment, lack of self-control, a sense of helplessness, chronic stress, war and several other factors make adopting a healthy lifestyle almost impossible. This is why our #ThinkSocial campaign is really a political campaign. Without politicians acknowledging the importance of the SDoH little will change. 

I am aware that the body mass index has been the most widely studied index of metabolic health. However, recent draft guidance from NICE suggests it can be misleading as it can miss abdominal obesity, which is a better proxy for metabolic health. People are now being encouraged to keep their waist measurement to less than half their height to reduce the risk of potential future health problems. NICE is now encouraging you to measure your own waist-to-height ratio and in conjunction with your BMI, it can help provide you a practical estimate of central adiposity, which is the accumulation of fat around the abdomen, to help to assess and predict health risks, such as type 2 diabetes, hypertension or cardiovascular disease.

So what is your waist-to-height ratio? 

If you are interested you can read the draft NICE guidelines and comment on them on the NICE website. 

NICE GUIDANCE - Obesity: identification and classification of overweight and obesity (update). In development [GID-NG10284]Expected publication date: 08 September 2022.

I suspect I am preaching to the converted and the question is how do we get this information out to those people who need it most? Any suggestions would be welcome. Thank you. 

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Paper 1

Li et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 2020;368:l6669.

Objective: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases.

Design: Prospective cohort study.

Setting and participants: The Nurses’ Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366).

Main exposures: Five low-risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).

Main outcome: Life expectancy free of diabetes, cardiovascular diseases, and cancer.

Results: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low-risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low-risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low-risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low-risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50.

Conclusion: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.

Paper 2

Dhana et al. Healthy lifestyle and life expectancy with and without Alzheimer's dementia: population-based cohort study. BMJ. 2022 Apr 13;377:e068390.

Objective: To determine the impact of lifestyle factors on life expectancy lived with and without Alzheimer's dementia.

Design: Prospective cohort study.

Setting: The Chicago Health and Aging Project, a population-based cohort study in the United States.

Participants: 2449 men and women aged 65 years and older.

Main exposure: A healthy lifestyle score was developed based on five modifiable lifestyle factors: a diet for brain health (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay-MIND diet score in upper 40% of cohort distribution), late-life cognitive activities (composite score in upper 40%), moderate or vigorous physical activity (≥150 min/week), no smoking, and light to moderate alcohol consumption (women 1-15 g/day; men 1-30 g/day).

Main outcome: Life expectancy with and without Alzheimer's dementia in women and men.

Results: Women aged 65 with four or five healthy factors had a life expectancy of 24.2 years (95% confidence interval 22.8 to 25.5) and lived 3.1 years longer than women aged 65 with zero or one healthy factor (life expectancy 21.1 years, 19.5 to 22.4). Of the total life expectancy at age 65, women with four or five healthy factors spent 10.8% (2.6 years, 2.0 to 3.3) of their remaining years with Alzheimer's dementia, whereas women with zero or one healthy factor spent 19.3% (4.1 years, 3.2 to 5.1) with the disease. Life expectancy for women aged 65 without Alzheimer's dementia and four or five healthy factors was 21.5 years (20.0 to 22.7), and for those with zero or one healthy factor, it was 17.0 years (15.5 to 18.3). Men aged 65 with four or five healthy factors had a total life expectancy of 23.1 years (21.4 to 25.6), which is 5.7 years longer than men aged 65 with zero or one healthy factor (life expectancy 17.4 years, 15.8 to 20.1). Of the total life expectancy at age 65, men with four or five healthy factors spent 6.1% (1.4 years, 0.3 to 2.0) of their remaining years with Alzheimer's dementia, and those with zero or one healthy factor spent 12.0% (2.1 years, 0.2 to 3.0) with the disease. Life expectancy for men aged 65 without Alzheimer's dementia and four or five healthy factors was 21.7 years (19.7 to 24.9), and for those with zero or one healthy factor life expectancy was 15.3 years (13.4 to 19.1).

Conclusion: A healthy lifestyle was associated with a longer life expectancy among men and women, and they lived a larger proportion of their remaining years without Alzheimer's dementia. The life expectancy estimates might help health professionals, policymakers, and stakeholders plan future healthcare services, costs, and needs.

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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Barts and The London School of Medicine and Dentistry or Barts Health NHS Trust. The advice is intended as general advice and should not be interpreted as personal clinical advice. If you have problems please tell your own healthcare professional who will be able to help you.