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The average life expectancy worldwide is approximately 73 years,1 and in the United States, statistics from 2021 estimate this number to be closer to 76 years of age.2 Chronic diseases are among the leading causes of disability and death across the globe, which has prompted additional investigation into not only how long people live (i.e., lifespan), but also how long they live in health (i.e., healthspan). What is the prevalence of morbidities across the lifespan, how does multimorbidity potentially shrink healthspan, and how can modifiable lifestyle factors such as diet and exercise positively impact healthy aging and longevity?
Multimorbidity & a Shrinking Healthspan
Multimorbidity indicates the presence of two or more chronic health conditions experienced by a person at the same time. According to the Centers for Disease Control and Prevention, six in ten US adults have a chronic disease and four in ten adults have two or more.3 Projections of the chronic disease and multimorbidity burden among US adults indicate that as the number of adults aged 50 years or older increases (projected to increase 61.1% between 2020 and 2050), the number of those 50 years or older with multimorbidity is projected to increase 91.2% between 2020 and 2050.4
A 2023 global meta-analysis of 126 peer-reviewed studies (n=15.4 million people; 32.1% male; mean age of 57 years; data from 54 countries) found that the worldwide prevalence of multimorbidity in community settings was 37.2%.5 Overall, multimorbidity was found to be more prevalent in females (39.4%) than males (32.8%), and researchers reported that more than half of the global adult population over 60 years old (51%) had multimorbid conditions.5 The study also indicated that multimorbidity has become increasingly prevalent in the last two decades, leading to higher mortality rates, increased healthcare utilization and costs, and reduced daily functioning and quality of life.5 Recent studies have echoed these results, finding associations between multimorbidity, reduced quality of life (i.e., physical, social, emotional, and functional well-being), and adverse health outcomes, with worse outcomes noted for older patients who reported an increased sense of loneliness.6
Creating Health & Enhancing Longevity
Research continues to report that maintaining a healthy lifestyle significantly reduces multimorbidity risk,7-9 optimizing healthy aging. Functional medicine clinicians proactively support healthspan by promoting lifestyle-based therapeutic approaches and personalized whole-body health and wellness for patients. In the following video, Terry Wahls, MD, IFMCP, talks about how the principles of functional medicine can be applied in any practice to create health.
Nutrition and Physical Activity
Healthy aging has been described as adding life quality to the years as we age. Some hallmarks of aging may be modifiable, and a wide array of research on nutrition and exercise over the last few years has pointed to the possibility of preventing chronic disease and extending healthspan. Nutrition is considered a cornerstone for the lifestyle-based prevention of age-related and chronic diseases.10-13 Some dietary patterns that support health include the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) diet, the 2020-2025 Dietary Guidelines for Americans, and the Healthy Eating Plate. These approaches focus on increasing the intake of unprocessed foods, fruits and vegetables, plant-based fats and proteins, legumes, whole grains, and nuts while reducing high sugar and sodium foods.
Advancements in the understanding of healthy aging also include research on the relationship between genetics, nutrition, and exercise. As an example, a recent pilot clinical trial found that after an eight-week treatment program that included a plant-centered diet, sleep, exercise, and relaxation guidance plus supplemental probiotics and phytonutrients, the epigenetic age of treatment participants decreased by 3.23 years compared to controls.14 Researchers also continue to investigate the impact of dietary patterns such as intermittent fasting on aging and longevity.15
In addition, even gentle physical activity may have health and aging benefits. In 2019, a meta-analysis and systematic review examined the effect of tai chi chuan (TCC)—sequences of very slow, controlled movements—on negative emotions in non-clinical populations.16 This mind-body practice significantly improved negative emotions in both young and older adults, finding that TCC is a worthy complementary non-pharmacological resource for depression and anxiety.16 Research continues to develop on the relationship between exercise and healthspan. Most recently, a 2022 meta-analysis of 15 studies that included data from over 77,000 older adults reported an inverse association between physical activity and multimorbidity.17
As multimorbidity and chronic disease prevalence persist, clinicians need therapeutic strategies and patient education to help with lifestyle changes. With the right tools, clinicians can empower patients to make the sustainable changes they need to support their lifespan as well as their healthspan. IFM provides clinicians with these tools to help their patients adopt heathy lifestyle practices (such as eating more high-quality foods that are rich in phytonutrients), address the underlying causes of age-related dysfunction, and support general health and wellness.
To read more about healthy aging and modifiable lifestyle factors such as social support and stress management, please see the related IFM-authored articles mentioned below. Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.
- The Global Health Observatory. Global health estimates: life expectancy and healthy life expectancy. World Health Organization. Accessed September 15, 2023. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy
- Xu JQ, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2021. NCHS Data Brief. 2022;(456):1-8. Accessed September 18, 2023. https://stacks.cdc.gov/view/cdc/122516
- National Center for Chronic Disease Prevention and Health Promotion. About chronic diseases. Centers for Disease Control and Prevention. Reviewed July 21, 2022. Accessed September 15, 2023. https://www.cdc.gov/chronicdisease/about/index.htm
- Ansah JP, Chiu CT. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health. 2023;10:1082183. doi:3389/fpubh.2022.1082183
- Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023;57:101860. doi:1016/j.eclinm.2023.101860
- Vespa A, Spatuzzi R, Fabbietti P, et al. Association between sense of loneliness and quality of life in older adults with multimorbidity. Int J Environ Res Public Health. 2023;20(3):2615. doi:3390/ijerph20032615
- Freisling H, Viallon V, Lennon H, et al. Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. BMC Med. 2020;18(1):5. doi:1186/s12916-019-1474-7
- Xie H, Li J, Zhu X, et al. Association between healthy lifestyle and the occurrence of cardiometabolic multimorbidity in hypertensive patients: a prospective cohort study of UK Biobank. Cardiovasc Diabetol. 2022;21(1):199. doi:1186/s12933-022-01632-3
- Kyprianidou M, Panagiotakos D, Faka A, Kambanaros M, Makris KC, Christophi CA. Adherence to the Mediterranean diet in Cyprus and its relationship to multi-morbidity: an epidemiological study. Public Health Nutr. 2021;24(14):4546-4555. doi:1017/S1368980020004267
- National Center for Chronic Disease Prevention and Health Promotion. How you can prevention chronic diseases. Centers for Disease Control and Prevention. Reviewed February 8, 2023. Accessed September 18, 2023. https://www.cdc.gov/chronicdisease/about/prevent/index.htm
- Fu J, Tan LJ, Lee JE, Shin S. Association between the Mediterranean diet and cognitive health among healthy adults: a systematic review and meta-analysis. Front Nutr. 2022;9:946361. doi:3389/fnut.2022.946361
- Haigh L, Kirk C, El Gendy K, et al. The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis. Clin Nutr. 2022;41(9):1913-1931. doi:1016/j.clnu.2022.06.037
- Filippou CD, Tsioufis CP, Thomopoulos CG, et al. Dietary Approaches to Stop Hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr. 2020;11(5):1150-1160. doi:1093/advances/nmaa041
- Fitzgerald KN, Hodges R, Hanes D, et al. Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial. Aging(Albany NY). 2021;13(7):9419-9432. doi:18632/aging.202913
- Lilja S, Stoll C, Krammer U, et al. Five days periodic fasting elevates levels of longevity related Christensenella and sirtuin expression in humans. Int J Mol Sci.2021;22(5):2331. doi:3390/ijms22052331
- Zhang S, Zou L, Chen LZ, et al. The effect of tai chi chuan on negative emotions in non-clinical populations: a meta-analysis and systematic review. Int J Environ Res Public Health. 2019;16(17):E3033. doi:3390/ijerph16173033
- Delpino FM, de Lima APM, da Silva BGC, Nunes BP, Caputo EL, Bielemann RM. Physical activity and multimorbidity among community-dwelling older adults: a systematic review with meta-analysis. Am J Health Promot. 2022;36(8):1371-1385. doi:1177/08901171221104458