Researchers are calling for a global revolution in preventative health amid data showing a sharp increase in the global disease burden due to metabolism-related risk factors.

It follows the release of figures revealing the number of people globally experiencing poor health and early death caused by high blood pressure, blood sugar, and BMI had increased by 50% since 2000, with little flattening of the curve over that time.

The data were published in The Lancet Global Burden of Diseases, Injuries, and Risk Factors Study, which also found ill health in younger people aged 15-49 was increasingly attributable to these risk factors (link here).

The study included comprehensive estimates of the risk-attributable burden for 204 countries and territories from 1990 to 2021 and highlighted the ongoing impact of particulate matter pollution, which was the largest contributor to the burden in 2021.

The researchers said this was despite significant improvements in household air pollution, particularly in South Asia and China, which were accompanied by increases in pollution from environmental and industrial sources.

However, according to the study, hypertension was the second-leading contributor to the risk-attributable burden, rising from fourth place in 2000.

The authors said high fasting plasma glucose (FPG) and high BMI showed a “concerning trend of substantial burden attributable to key metabolic risks.”

“The burden attributable to high systolic blood pressure represents a continuing challenge and remains particularly impactful outside of most high-income countries, with reductions in burden limited in geographical scope,” they wrote.

“High FPG and high BMI stand out as risks for which both exposure and burden have increased considerably in almost all regions of the world.”

The researchers said projected increases in rates of T2DM and other conditions related to high BMI, such as musculoskeletal disorders, underscored the need for serious policy interventions around the world.

“Such actions could include evidence-based prevention efforts, treatment, or upstream socioeconomic policies to reduce underlying DALY rates,” they added.

“Balancing risk exposure reduction with other approaches might be more beneficial in cases where a single risk factor contributes to multiple outcomes (eg, low physical activity, high systolic blood pressure, high BMI, and high FPG), especially when clear and compelling evidence exists of the effectiveness of specific interventions.”

Smoking was the third-leading risk factor, followed by low birthweight and short gestation, despite major improvements in the risk-attributable burden related to child and maternal malnutrition and health over the study period, including a more than 70% reduction in the rate of age-standardised DALYs attributable to child growth failure.

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

These numbers suggested that public health measures and humanitarian health initiatives of the past three decades had been successful, with particularly high rates of decline in burden attributable to these risk factors in areas ranking lower on the Socio-demographic Index, a measure of income, fertility, and education, according to the authors.