One of the
more controversial papers ever to be published in the prestigious New England Journal of Medicine
projected that “the steady rise in life
expectancy which had occurred over the past 2 centuries may soon come to an end.” They ended the conclusion commenting that the
youth of today may live less healthy and shorter lives than their parents. As would be expected this paper sparked a
large volume of letters to the editor criticizing this projection.
While the
authors based their projection on some very sound data, the real validation
could only come with time. As my
favorite philosopher, Yogi Berra once said when asked to predict on Thursday
who would win a golf tournament which ended Sunday, “ask me Sunday night. I am a lot better at predicting the past than
I am the future.”
While
“Sunday night” is not here on this striking prediction about our children’s
longevity, the preliminary data appears to be supporting this grim
projection. The primary basis of this
projection was the ever growing rate of obesity and its relationship to
increased rates of the chronic diseases such as diabetes, heart disease, cancer
and many others.
As
projected, overweight and obesity trends have continued upward across all
population groups. Currently about 9% of
children 5 years of age and under are obese, and this rises to 20.5% between 12
and 19 years. The increasing trend
continues throughout adulthood.
Currently 38% of U.S. adults are obese and 74% are overweight.
Diabetes is
perhaps the best leading edge indicator of the disease trends that may
accompany the overweight and obesity change.
It is now projected that the 14.3% of the U.S. population have diabetes
an increase of approximately 300% since 1990.
The real emphasis comes from the fact that fully 38%, or about 1 of
every 3 persons in the U.S., is pre-diabetic with a high percentage expected to
convert to full diabetes over time.
Pre-diabetes
is a misleading term in some ways. Normal fasting blood glucose is 70-99
mg/dL. Diabetes is a fasting glucose of
140 or greater. Pre-diabetes is that
zone of abnormal glucose from 100-139. My
take on pre-diabetes is that just as the first trimester of pregnancy is not
“pre-pregnant” but is early pregnancy, the better term is early diabetes.
These trends
are fueled by the general belief by most that no matter what they do to
themselves, some medical innovation will bail them out. At least some knowledgeable healthcare
scientists seem to accept that the rate at which we can become diseased is
beginning to outpace the ability to maintain chronic disease. One trend that supports this concept is
another important statistic, healthy longevity. It is defined as age of onset of the first
chronic disease.
Even as
longevity has increased over the past 60 years, healthy longevity has
decreased more dramatically.
This is what the authors of the NEJM paper referred to as “our children living less healthy lives than
their parents”. Many treatments for chronic disease do not completely
prevent the complications that often shorten life but rather they delay
them. The diabetic today has their
disease longer than previous generations.
The average
onset of type II diabetes was 52 years of age 40 years
ago. It is now 41 years of age. While improvements in diabetes treatment have
delayed the onset of complications, the earlier ages of onset may begin to
override treatment based complication delays.
One of the
most striking papers I have read was a commentary by an endocrinologist at the
University of Texas. He had been in
practice 30 years and commented that in his early years they would see perhaps
only a couple of new onset cases of type II diabetes in adolescents each year. Now they see several new cases every
week. This phenomenon was why the
terminology when I was in graduate school, adult onset diabetes, was changed to
type II diabetes.
This paper
making these projections that received so much criticism in 2005 is being
looked at as evolving reality in 2017.
Sad but true.
There is
little disagreement that the primary driver of the chronic disease epidemic is
diet based. Likewise, the most effective
solution will also be diet based.
Perhaps one of the best health investments we can make is to get some
help from a nutritional health professional in understanding and optimizing our
diet as well as that of our families.
Olshansky et
al. A
Potential Decline in Life Expectancy in the United States in the 21st Century. New England Journal of Medicine, 2005:352;11.
