Sub-health has become a hot research areas

Sub-health has become a hot research areas


A full evaluation of health conditions is necessary for the effective implementation of public health interventions. However, terms to address the intermediate state between health and disease are lacking, leading the public to overlook this state and thus increasing the risks of developing disease.

Sub-health condition is defined by the WHO (World Health Organization) as a state between health and disease or a ‘gray state of health’, when all necessary physical and chemical indexes are tested negative by medical equipments, things seem normal but the person experiences all kind of discomfiture and even pain.

From this definition, if there are signs of problems in your body, or some inadequacy with your emotion, social ability, flexibility and attitude towards life, you are not healthy. Health is measured by a holistic condition.

According to the World Health Organization (WHO), 75% of us are actually living in a sub-healthy condition brought about by increased pressures of living which is taking a toll on our health.

WHO has pointed out that there are:

• 5% of the people are healthy in accordance with the healthy standard of WHO
• 20% have various diseases
• 75% are in the sub-healthy condition

Human’s health condition is a continuing changing process from healthy, sub-healthy to disease. 


A cross-sectional health survey of 1,473 randomly recruited Chinese Han adults of both sexes living in the central region of China. The criteria for diagnosis of subhealth was defined as the presence of ≥ 1 of the following abnormalities: body mass index ≥ 25 kg/m2 or waist circumference ≥ 102 cm in men and 88 cm in women; systolic pressure 120–139 mmHg and/or diastolic pressure 80–89 mmHg; serum triglyceride level ≥ 150 mg/dL and/or total cholesterol level ≥ 200 mg/dL and/or high-density lipoprotein cholesterol level < 40 mg/dL in men and 50 mg/dL in women; serum glucose level 110–125 mg/dL; estimated glomerular filtration rate 60–89 ml/min/1.73 m2; levels of liver enzymes in liver function tests between 41–59 U/L, or with fatty liver disease but < 33% of affected hepatocytes; levels of oxidative stress biomarkers beyond the reference range of 95%; or problems with both sleep quality and psychological state.

When one’s body in a sub-health condition, his/her organs will undergoing aging and degrading process and progressively weakens your immunity. If neglected, he/she will have immunity breakdown and prone to illnesses. Thus, prevention is an imperative -"An Ounce of Prevention is Worth a Pound of Cure”.


The prevalences of subhealth and disease in the central region of China were 36.6% and 43.1%, respectively. The prevalence of disease increased from 26.3% in participants aged 20–39 years, to 47.6% and 78.9% for participants aged 40–59 years and those aged 60 years or older, respectively. Compared with participants aged 20–39, the prevalences of health and subhealth in participants aged 60 years or older decreased by 86.7% and 60.3%, respectively. The prevalence of subhealth was increased in association with increases in lifestyle risk scores, while the prevalences of both health and disease were reduced.
To our knowledge, this is the first definition for subhealth that fills the terminology gap between health and disease. This definition is necessary to draw people’s attention to their lifestyles, and to allow them to recover their physical and psychological states of health. If we regard health and disease as green and red traffic lights, respectively, then subhealth is the amber light. The absence of any light will increase the risk of a health-state traffic jam, as indicated by the results of this study. Subhealthy participants had the highest LRS, and only the prevalence of subhealth was positively associated with LRS. It is possible that, in the absence of any term defining the subhealthy condition, people fail to see the amber light and do not appreciate the need to make changes to their lifestyles or other factors.
We have therefore developed systematic diagnostic criteria for subhealth, based on the diagnostic criteria for metabolic syndrome [10,12,14], supplemented by measures of oxidative stress to represent general stress, combined sleep and psychological state for mental status, CKD-EPI-based eGFR for renal function, and liver related examinations for hepatic function state. These criteria, including general stress and physical and psychological conditions, provide information about the overall state of health. Moreover, a diagnosis is not difficult to achieve. It is possible to focus on an organ for organ-specific subhealth, or add an index of general stress and an easily-completed questionnaire and medical examination for overall subhealth.
The difference between subhealth and disease lies not only in the levels of the indices used, but more importantly in the means to recovery: generally, the cure of disease requires medication, while the threat to public health posed by subhealth can be eliminated simply by psychological interventions and/or lifestyle modifications. Several studies have suggested that physical activity, healthy diet and other lifestyle modifications can favorably affect components of subhealth [34-36]. However, subhealthy individuals are at high risk of developing disease if not treated in time.
Unhealthy lifestyles are associated with high risks of disease and mortality, while lifestyle improvements are associated with reductions in disease and all-cause mortality. Numerous studies have illustrated that healthy diet, moderate exercise, quitting cigarette smoking, and avoiding heavy drinking are separately associated with lower rates of death from all causes [37-42]. However, there are limited published studies reporting the relationship between combined lifestyle factors and mortality or diseases. By assigning a score of 1 for each poor lifestyle factor (unhealthy diet, sleep problems, smoking, drinking, and < 1 hour of physical activity per week) we calculated a combined LRS ranging from 0–5 for each subject. Based on this score, we demonstrated a positive effect of LRS on the prevalence of subhealth, and a negative effect on health and disease. It is possible that participants with disease, but not those defined as subhealthy, paid more attention to their lifestyles, which might explain why the correlations between mortality or disease and independent lifestyle factors was not always consistent.
In this cross-sectional study, we found approximately 80% of Chinese adults were subhealthy or diseased, based on our diagnostic criteria. This result is much higher than the reported prevalence of metabolic syndrome (23.7%), and even higher than the prevalence of one abnormal characteristic of metabolic syndrome (71.2%) reported in the Third National Health and Nutrition Examination Survey [43]. However, appropriate interventions could theoretically recover health from subhealth (with a prevalence of 36.6%). There is therefore an urgent need for the government, especially the health care sector, to make comprehensive efforts to lower the prevalence of subhealth. The cornerstone of intervention should be to reduce the LRS to zero.
The strengths of this study include the fact that it provides the first definition and criteria for the diagnosis of subhealth, making evaluation of the full state of health conditions feasible, and allowing the implementation of effective interventions. The application of LRS to investigate the combined impact of lifestyle factors on subhealth or disease is superior to assessing the independent impact of lifestyle factors. This cross-sectional study revealed a high prevalence of subhealth in the central region of China, which may serve prompt a major health care initiative aimed at treating subhealth, which has previously been ignored.


The prevalences of subhealth and disease are high in central China. Subhealth is associated with high lifestyle risk scores. Both the health care sector and the public should pay more attention to subhealth. Lifestyle modifications and/or psychological interventions are needed to ameliorate these conditions.

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