Shadow of woman in yoga pose

Suboptimal
Health

ECU research aims to bring more precision to preventative health care

The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

For many, that level of health remains elusive — there is an increasing number of individuals worldwide who report a general malaise even in the absence of a diagnosable disorder.

Professor Wei Wang, Pro-Vice-Chancellor at Edith Cowan University (ECU) coined the term "suboptimal health status" to describe this condition, and has developed a tool to measure "SHS", with the goal of bringing more precision to preventative health care.

Wang and his team at ECU define suboptimal health as "a physical state between health and disease," characterized by ambiguous health complaints as well as general weakness and periods of low energy. Wang, who has been studying medicine for 30 years, says suboptimal health also describes a reversible stage of a chronic disease, which is a crucial distinction in how physicians can approach any number of health conditions.

There is an increasing number of individuals worldwide who report a general malaise even in the absence of a diagnosable disorder.

Addressing a public-health challenge

In Professor Wang's native China, there has been an increase in the number of people who report symptoms indicating illness, but without the presence of a specific disease or disorder. Drawing on his familiarity with traditional Chinese medicine, which has long identified a physical state between health and disease, Wang developed a comprehensive suboptimal health questionnaire in 2009, called SHSQ-25. He now leads two teams in SHS study — one at ECU and another in Beijing.

In 2010, researchers used Wang's questionnaire as part of a study associating SHS and cardiovascular risk factors among urban Chinese workers. The study of 4,881 workers measured blood pressure, glucose levels, body mass, and other factors linked to cardiovascular disease, with an overall 'SHS score' derived from these results and data collected in the questionnaire.

Thanks in part to Wang's survey, the study found a correlation between SHS and various cardiovascular disease risk factors. As treatments for cardiovascular and other non-communicable illnesses are often implemented after disease onset, understanding SHS is a means of approaching health complaints from the perspective of predictive, preventive, and personalised medicine, Wang says.

"Suboptimal health status is associated with cardiovascular risk factors and contributes to the development of the disease," he says. "SHS should be recognized in the health-care system, especially in primary care."

A powerful predictive instrument

An author of over 200 scientific papers on suboptimal health and related topics, Wang created the questionnaire keeping in mind the increased relevance of SHS intervention and prognosis. Focus-group discussions provided the basis for the survey, while a small pilot study included tests for reliability and internal consistency. The final questionnaire is short and easy to complete, containing 25 items narrowed down to five subcategories: fatigue, the cardiovascular system, digestive system, immune system, and mental health status.

Experts say China — whose recently abolished one-child family-planning policy has resulted in a rapidly aging population — has a higher incidence of chronic illnesses than other middle-income countries. For example, Wang points to a nationwide onslaught of dementia forecasted by the WHO to reach 23.3 million cases by 2030.

Understanding SHS is a means of approaching health complaints from the perspective of predictive, preventive, and personalised medicine.

The Human Glycome Project

In recent years, Professor Wang's work has centered on using glycans to produce an objective measure of suboptimal health. Known generally as simple and complex carbohydrates, glycans have long been known to play major metabolic, structural, and physical roles in biological systems.

As a committee member and key researcher in the Human Glycome Project, Wang aims to understand the role glycans play in the progress of diabetes, cardiovascular disorder, and other chronic illnesses. According to Wang, glycans can also be objective health markers — a powerful predictor when integrated with the suboptimal health measures endorsed by the university.

ECU's questionnaire has already been translated into Chinese, English and Russian. Use of the tool across additional populations can result in early detection of chronic diseases, says Professor Wang, ideally reducing the burden these illnesses place on society.

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