What is multimorbidity, and is it increasing in younger age groups, middle age, and the elderly?

Multimorbidity is the co-occurrence of three or more chronic conditions. It is more common to have multiple conditions (multimorbidity) than a single condition in New Zealand. People across the Western world are diagnosed at younger and younger ages with multiple conditions which include metabolic, inflammatory and brain-related conditions. Multimorbidity occurs a decade earlier in deprived communities.

The societal cost of multimorbidity is super-additive.

Metabolic syndrome is one example of how metabolic disturbances drive multimorbidity. Yet people who present with metabolic syndrome, which includes the overlapping conditions of hypertension, dyslipidaemia, type 2 diabetes mellitus, obesity, and inflammation, also are more likely to be diagnosed with a mental illness or brain-related disorder. Metabolic dysfunction is strongly correlated with risk for brain-related conditions and periodontal disease, yet these associations are rarely raised by health agencies.

In many individuals, metabolic disturbances precede the onset of psychiatric symptoms and formal diagnosis. Clinical presentation in a doctors’ clinic by a patient, can reflect the complex interplay of genetic and epigenetic predispositions, dietary nutrient status, toxic exposures, and familial patterns. Lifestyle factors such as sleep disruption and physical inactivity further modulate this relationship, and the interaction is bidirectional: mental disorders can exacerbate metabolic dysfunction via neuroendocrine and behavioural pathways.

Dietary and nutritional intake can support mitochondrial and cellular health, or it can disrupt it. Poor diets which chronically elevate blood-glucose, which drive inflammation, and which lack the nutrient inputs to support repair and homeostasis, can then 'set the scene' for cascading events that produce different symptoms across the body which are then diagnosed as different illnesses. Nutrients are absorbed even more rapidly during traumatic events, or amid periods of persistent stress, this can increase the potential for a mental and metabolic condition to appear. People have different genetic and epigenetic traits, different environmental exposures, and these will influence what type of symptom, illness or syndrome is diagnosed, and how vulnerable that person is to infectious and bacterial disease. Often it is a mixture of symptoms and illnesses, mental and metabolic that arise as a cascade over time - multimorbidity.

Emerging lines of evidence indicate that the metabolic and mental-illness crisis is amplified by a class of food products, ultra-processed foods, that are engineered to be hyper-palatable and addictive. Ultra-processed foods can layer on top of diets that are already high in rapidly digestible starches.

This information comes from Reclaiming Health, chapter 1, with references.

What is multimorbidity, and is it increasing in younger age groups, middle age, and the elderly?

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