International Journal of Disease Reversal and Prevention

Most US Adults with Obesity, Hypertension, or Diabetes Rate Their Own Health as Good or Better: A Cross-Sectional Analysis of Two National Surveys

2026-08-22T04:22:48+00:00

Background: Obesity, hypertension, and type 2 diabetes are highly prevalent and, in contrast to many chronic conditions, are substantially modifiable through dietary and lifestyle interventions. Although perceived need is widely considered a prerequisite for behavior change, the national prevalence of adults with these conditions who still rate their health as good has not been quantified.

Methods: A cross-sectional analysis was performed using the 2023 Behavioral Risk Factor Surveillance System (BRFSS; n = 389,862), with an independent replication in the 2024 National Health Interview Survey (NHIS; n = 31,736). Self-rated health was dichotomized as good, very good, or excellent versus fair or poor. Obesity was defined as a body mass index of 30 kg/m. or greater based on self-reported height and weight; hypertension and diabetes were defined by self-reported prior diagnosis. Weighted prevalences were estimated using Taylor-series linearization, and survey-weighted modified Poisson models were fitted to obtain adjusted prevalence ratios (aPRs).

Results: Among adults with at least one of the three conditions, 73.3% (95% CI, 72.9–73.7) rated their health as good, very good, or excellent, representing 89.0 million US adults. The proportion decreased as the number of conditions increased: 89.7% with none, 79.4% with one, 67.9% with two, and 50.3% (95% CI, 48.8–51.8) among those with all three. Favorable ratings were most common at younger ages and increased substantially with income, from 44.8% among adults with household income below $15,000 to 90.6% at $200,000 or more. Under a stricter threshold, 35.5% rated their health as very good or excellent, and 8.6% as excellent. Favorable ratings declined with disease severity but persisted, reaching 59.3% among adults with class III obesity, 51.8% among those with diabetes of 20 years or longer, and 39.9% among those with all three conditions and class III obesity. In fully adjusted models, each condition was associated with only a modest reduction in the prevalence of favorable self-rated health (obesity aPR 0.95; hypertension aPR 0.94; diabetes aPR 0.81). The National Health Interview Survey (NHIS) replicated both the magnitude and gradient. Unexpectedly, adults with these conditions who rated their health favorably reported more physical activity and less smoking than those rating it unfavorably.

Conclusions: The majority of US adults living with obesity, hypertension, or diabetes consider their general health to be good or better. These data establish favorable general health perception; they do not establish that these adults are unaware of their diagnoses or that they underestimate their future risk. As these conditions are often asymptomatic and substantially reversible, favorable self-assessment may represent an under-recognized context for lifestyle intervention. The impact of modifying self-perception on intervention uptake or health outcomes is unclear and should not be presumed.

Healthful Plant-Based Diet Index and Physical Activity Are Associated with Adiposity and the Triglyceride-HDL Axis but Not Apolipoprotein B: NHANES 2007–2016

2026-09-08T04:19:36+00:00

Background: Apolipoprotein B (apoB) is the most direct indicator of the circulating atherogenic particle burden. Randomized trials indicate that vegetarian and vegan diets lower apoB. However, the association between population-level variation in plant-based diet quality, alone or with physical activity, and apoB has not been examined.

Objective: To evaluate associations between the healthful plant-based diet index (hPDI) and physical activity and apoB and a panel of atherogenic and metabolic risk markers in a nationally representative sample of US adults.

Methods: Data from 10,545 non-pregnant adults aged 20 years and older who underwent fasting blood collection in the National Health and Nutrition Examination Survey (2007–2016) were analyzed. Plant-based diet indices were derived from 24-hour dietary recalls linked to the United States Department of Agriculture (USDA) Food Patterns Equivalents Database. Physical activity was quantified as metabolic equivalent minutes per week using the Global Physical Activity Questionnaire. Survey-weighted linear regression with Taylor series linearization was applied throughout. Analyses were exploratory; apoB and seven additional atherogenic and metabolic outcomes were examined and adjusted for multiplicity using the Benjamini-Hochberg procedure. A saturated-fat-aware variant of the index, scoring total solid fat in place of animal fat, was examined as a sensitivity analysis.

Results: Higher hPDI was not significantly associated with apoB (-0.26 mg/dL per 1 standard deviation [SD], 95% CI -0.89 to 0.38, P = .42), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), or total cholesterol. In the same models, higher hPDI was associated with lower body mass index (-0.71 kg/m2, 95% CI -0.90 to -0.52), lower waist circumference (-1.67 cm, 95% CI -2.13 to -1.21), and higher HDL cholesterol (0.85 mg/dL, 95% CI 0.47 to 1.23), all q < .001. In a model omitting body mass index, which estimates the total rather than the adiposity-independent association, the apoB estimate was -0.70 mg/dL per 1 SD (95% CI -1.34 to -0.06). No significant interaction between diet and physical activity was detected. Equivalence testing excluded an apoB difference greater than 5 mg/dL across the 10th to 90th percentile of hPDI, against a bound benchmarked to trial effect sizes rather than an established clinical threshold. Adults in the highest hPDI quintile obtained 9.9% of energy from saturated fat, and saturated fat intake was itself associated with LDL-C. Across quintiles, nuts, whole grains, and whole fruit increased several-fold and sugar-sweetened beverages decreased by 87%, whereas dairy intake was essentially unchanged and total solid fat decreased by 40%. A saturated-fat-aware index gave the same null result for apoB (-0.24 mg/dL per 1 SD, 95% CI -0.88 to 0.40).

Conclusions: Higher hPDI scores and physical activity were associated with more favorable adiposity and triglyceride-HDL measures, but not with apoB or other atherogenic lipid markers after adjustment for body mass index. The hPDI gradient did not capture differences in saturated fat intake, or in the foods that supply it, large enough to distinguish dietary patterns associated with lower apoB, and an index amended to score total solid fat behaved no differently. These findings characterize the index as an exposure measure and do not address the effects of plant-based dietary interventions, which have lowered apoB in randomized trials. Improving plant-based diet quality may confer metabolic benefit, while additional targeted reduction of saturated fat may be needed to lower atherogenic lipoprotein burden.

Testosterone Replacement Therapy in Aging Men: A Critical Appraisal of Evidence, Risks, and Benefits

2026-08-15T04:09:39+00:00

Testosterone replacement therapy (TRT) use has increased substantially over the past two decades. This narrative review evaluates the evidence for TRT in aging men and finds that age-related decline in testosterone concentrations frequently reflects accumulated comorbidity rather than primary testicular failure. Obesity-related and functional hypogonadism are potentially reversible conditions, and lifestyle modification, principally weight reduction and structured exercise, can restore endogenous testosterone production and should be offered first. Randomized trials demonstrate domainspecific and generally modest benefits. Sexual function improves consistently, but by less than the minimum clinically important difference in men with moderate-to-severe erectile dysfunction. Anemia correction is clinically meaningful, although it reflects the same erythropoietic effect that produces erythrocytosis. Bone mineral density increases without a corresponding reduction in fractures. Pre-specified primary outcomes for cognition and physical function were null, with small improvements on secondary measures of mood and vitality. The TRAVERSE trial established cardiovascular noninferiority for major adverse cardiac events over a mean of 21.7 months of treatment, and in February 2025, the United States Food and Drug Administration removed the cardiovascular boxed warning from testosterone products while retaining its limitation of use for age-related hypogonadism. Earlier adverse signals, including coronary plaque progression, an early-terminated trial in men with mobility limitation, and a non-industry-funded meta-analysis, derive from small or short studies and are best interpreted alongside TRAVERSE rather than in place of it. Confirmatory diagnostic testing remains uncommon in practice. Notwithstanding the absence of definitive comparative trials, lifestyle modification, addressing the causes rather than the consequences of testosterone deficiency, should precede TRT, which is best reserved for men with unequivocally and persistently low testosterone concentrations and consistent symptoms, particularly unexplained anemia or reduced libido, following shared decision-making.

Effect of a Whole Food, Plant-Based Diet on Cardiovascular Risk-Factors Among U.S. Veterans: A Pilot Study

2026-08-25T03:45:27+00:00

Objectives: This study aimed to preliminarily test the effectiveness of a commercial online nutrition program to promote adoption of a whole food, plant-based diet (WFPB) and reduce metabolic cardiovascular risk factors in veterans, compared to the Veterans Affairs (VA) online standard-of-care (SoC) treatment.

Methods: A 12-month randomized controlled trial design was used to pilot this comparison. Veterans with diabetes, hyperlipidemia, hypertension, or overweight/obesity, and an interest and desire to make a lifestyle change were recruited. Veterans were randomized 2:1 to the online WFPB diet treatment arm (WFPB) or the VA standard-of-care (SoC) online weight management program. Baseline anthropometrics, biochemistries, and dietary patterns were measured. Dietary intake was collected using 3-day food records and the 4Leaf survey. Measures were repeated at three, six, and 12 months.

Results: Ninety-two veterans (28% females) were randomized, and 49 completed the study. There was no difference in age (WFPB vs. SoC: 60 Å} 13 vs. 64 Å} 11 years) or baseline metabolic indicators (body mass index: 35 Å} 5 vs. 35 Å} 4 kg/m2; total cholesterol: 181 Å} 51 vs. 171 Å} 41 mg/dL; hemoglobin A1c [HbA1c]: 6.3 Å} 1 vs. 6.4% Å} 1%) between groups (p > 0.05). More females were enrolled in WFPB vs. SoC (34% vs. 8%, p = 0.01). After 12 months, baseline calorie intake from whole plant foods increased from 23% (p > 0.9999) to 36% and 41% in WFPB and SoC, respectively (p = 0.0146). The WFPB group lost more weight over one year compared with SoC (3.4% Å} 4.7% vs. 1.7% Å} 4.9%, p = 0.014). Total cholesterol decreased significantly in WFPB males. High-density lipoprotein cholesterol (HDL-C) increased in the WFPB group. There were no statistically significant changes in blood pressure, low-density lipoprotein cholesterol (LDL-C), or HbA1c in either group.

Conclusions: Both groups increased the percent calories consumed from whole plant foods; the range of change was 20–40%. The WFPB group showed the most rapid change, while the SoC group showed a more gradual but sustained change, resulting in partial convergence of the long-term dietary pattern. This increase did not sufficiently lower LDL-C levels. Other factors, including medication use and small sample size, may have contributed to this result. The WFPB program promoted greater weight loss over 12 months in veterans compared with the current VA SoC. In clinical settings where intensive meal-based programs are not feasible, publicly available online technologies to complement provider interaction offer a promising alternative.

Dietary and Supplemental Taurine for Health and Exercise Performance Outcomes in Plant-Based and Omnivorous Diets: A Narrative Review

2026-08-25T03:54:37+00:00

Taurine is a conditionally essential amino acid synthesized endogenously from cysteine that participates in bile acid conjugation, calcium homeostasis, and immune function. Plant-based diets provide negligible dietary taurine and are associated with lower plasma taurine concentrations in vegans compared with omnivores, raising questions about whether this difference compromises health or exercise performance. This narrative review synthesized evidence from systematic reviews, meta-analyses, randomized controlled trials, observational studies, and mechanistic research across five domains: aging, cognitive function, cardiometabolic health, colorectal cancer risk, and exercise performance. Despite lower circulating taurine in plant-based populations, clinical taurine deficiency has never been documented in this group. The supplemental doses shown to produce beneficial effects in intervention trials far exceed what any diet, omnivorous or plant-based, can provide, rendering dietary taurine differences between the two patterns clinically inconsequential for achieving pharmacological effects. Emerging evidence also links high-dose taurine supplementation to increased colorectal cancer risk via taurine-conjugated bile acid pathways. Individuals following plant-based diets consistently show outcomes comparable to or superior to omnivores across all examined endpoints. Current evidence does not support the suggestion that individuals following plant-based diets require routine taurine supplementation.

Muscle-Strengthening Activity, Psychological Distress, and Self-Rated Health Among US Adults: A Nationally Representative Analysis of the Neglected Exercise Pillar of Lifestyle Medicine

2026-09-10T03:53:24+00:00

Objectives: To examine associations of muscle-strengthening activity with psychological distress and self-rated health among US adults, adjusting for aerobic activity and other lifestyle pillars.

Methods: We analyzed 7,278 adults in the Health Information National Trends Survey (HINTS 7, 2024). Participants self-reported muscle-strengthening (days/week) and moderate aerobic activity. Outcomes were psychological distress (Patient Health Questionnaire-4, 0–12) and self-rated health (1 = excellent to 5 = poor); complete-case analytic samples were 5,485 and 5,511, respectively. Weighted linear and logistic regression with jackknife variance estimation adjusted for demographics, socioeconomic status, aerobic activity, adiposity, smoking, diet, food insecurity, social isolation, sleep, and mobility limitation.

Results: 41.6% met the muscle-strengthening guideline (≥ 2 days/week); 47.5% reported none. Each standard-deviation increment (≈ 2 days/week) was associated with lower distress (β = −0.12; 95% confidence interval [CI], −0.22 to −0.02; p = .021) and better self-rated health (β = −0.13; 95% CI, −0.18 to −0.08; p < .001) after adjustment. The association held for depressive symptoms (p = .014) but not for anxiety symptoms (p = .21). Aerobic activity was not associated with either continuous outcome (distress, p = .29; health, p = .54), although meeting the aerobic guideline, but not the musclestrengthening guideline, was associated with lower odds of fair or poor health. Distress was lowest at 2–3 days/week.

Conclusion: Muscle-strengthening activity remained associated with lower psychological distress and better self-rated health after adjustment for measured demographic, socioeconomic, behavioral, and health covariates. These cross-sectional data cannot establish direction or indicate that resistance exercise is superior to aerobic exercise. With low population uptake and existing trial evidence, they support prospective randomized evaluation of resistance training within lifestyle medicine.

Insufficient Evidence for Collagen Supplementation: A Critical Examination of Skin, Musculoskeletal, and Joint Health Claims

2026-09-15T03:46:47+00:00

Background: Collagen supplementation has grown exponentially in the nutraceutical market, driven by marketing claims of benefits for skin aging, body composition, and joint health. This narrative review critically examines current evidence for oral collagen supplementation across these domains, emphasizing methodological quality, industryfunding influence, and biological plausibility.

Methods: A literature search of PubMed and Google Scholar identified randomized controlled trials, systematic reviews, meta-analyses, and commentaries published between 2000 and June 2025, with an updated search in December 2025 to capture subsequently published trials, meta-analyses, and published corrections. Data were synthesized thematically to evaluate the strength of evidence and identify conflicts between marketing claims and scientific findings. Screening and selection followed a structured narrative-review approach; risk of bias and certainty of evidence were taken from the appraisals reported within the included reviews rather than from de novo assessment of individual trials. Where recent syntheses reached differing conclusions, the individual trials underlying their pooled estimates were retrieved and appraised against the primary reports.

Results: For skin health, apparent benefits from pooled analyses disappeared entirely when studies were stratified by funding source and methodological quality. Studies without pharmaceutical company funding showed no significant effects on skin hydration, elasticity, or wrinkles, while industry-funded studies demonstrated significant improvements. Statistical heterogeneity was extremely high across multiple meta-analyses, with I^2. values of 78–98%. For musculoskeletal outcomes, systematic reviews found inconsistent results, with evidence suggesting that total protein quantity and amino acid profile may be more influential than protein type for muscle protein synthesis and body composition. Critical examination of remarkable body composition claims identified significant mechanistic implausibility regarding leucine content and proposed anabolic pathways. For joint health, recent meta-analyses report small improvements in osteoarthritis pain and function. The largest and most methodologically current of these produced a pooled pain effect (SMD −0.35) that falls below the minimal clinically important difference its own authors pre-specified (−0.37), concentrated that effect in undenatured type II collagen rather than in the hydrolysate preparations that dominate the consumer market, showed statistically significant small-study bias until the smallest trials were excluded, and classified as independently funded no trial that tested oral collagen against placebo in knee osteoarthritis. Studies in healthy individuals with knee pain and patients with knee osteoarthritis showed no benefit over placebo.

Conclusions: Current evidence does not support collagen supplementation for skin health, body composition, or muscle strength when analyses are restricted to high-quality, independently funded research. For joint health, a small pooled benefit is reported, but it falls below the threshold for clinical importance nominated by the syntheses reporting it and rests on a literature in which oral supplementation has not been tested against placebo by independently funded investigators. The evidence base is characterized by methodological heterogeneity, potential industry-funding influence, and signs of publication bias. Until large, well-designed trials demonstrate clinically meaningful benefits compared with non-collagen protein sources, with plausible biological mechanisms, collagen supplementation should not be recommended as an evidence-based intervention.

Identifying Opportunities for Food-as-Medicine Programs: A Latent Class Analysis of Cardiometabolic Risk, Health Care Engagement, and Dietary Behavior Among US Adults

2026-09-07T22:43:23+00:00

Background: Food-as-medicine programs are expanding rapidly in US healthcare systems, but eligibility is generally determined solely by diagnosis and food insecurity. Whether this identifies the populations with the most room to benefit is unclear. Recruitment occurs through clinical channels, so opportunity depends on the intersection of cardiometabolic risk, healthcare engagement, and room for dietary improvement—a combination not yet characterized at the population level.

Methods: The 2021 Behavioral Risk Factor Surveillance System (n = 438,670 adults) and the 2024 National Health Interview Survey (NHIS; n = 32,629) were analyzed, the latter as a confirmatory sample. Survey-weighted latent class analysis was applied to 15 binary indicators encompassing cardiometabolic risk, healthcare engagement, dietary behavior, physical activity, psychological distress, and self-rated health. Dietary behavior was limited to fruit and vegetable intake frequency; sodium, saturated fat, and ultra-processed food intake were not measured. Models with one to eight classes were estimated using expectation maximization with full-information maximum likelihood
for item nonresponse. Class profiles were compared across the 13 indicators common to both surveys.

Results: A six-class solution was identified. One segment (16.3% of adults, 40.1 million) combined elevated cardiometabolic risk (37.1% obesity, 23.3% high cholesterol) with substantial healthcare engagement (75.0% routine checkup, 98.1% insured) and the lowest fruit and vegetable intake of any class (72.6% and 47.5%, respectively, less than once daily). Two additional engaged segments carried greater disease burden yet reported higher intake. A sixth segment (5.6%, 13.7 million) displayed similar risk but disrupted access, with 66.0% reporting cost barriers and 36.9% food insecure in NHIS. Five of six classes had corresponding NHIS profiles (r ≥ 0.76); the diet-defined segment did not.

Conclusions: Population segments differ substantially in cardiometabolic need, opportunity for dietary improvement, and clinical reachability. A large, clinically reachable segment reporting low fruit and vegetable intake is underrecognized by current eligibility criteria, whereas the segment with the greatest need remains largely unreachable through clinical referral. These characteristics can identify populations in whom intervention may be feasible and potentially beneficial, but willingness to change, uptake, adherence, and subsequent dietary and clinical response require prospective assessment.