Why has my HHS changed? 

The HHS now reflects your health risk more accurately and, since it indicates progressive damage that might be induced by unacceptable values, encourages prevention and action. If such unacceptable values continue, it can result in progressive damage that can increase your risk of suffering adverse health consequences. 

How is the HHS calculated? 

The parameters used to calculate your HHS are : estimated body fat, blood pressure, glucose (or HbA1c if available), total cholesterol (and HDL cholesterol if available) and smoking status.

How was the HHS developed?

The revised HHS is based on research from 35 000 MMI clients’ health assessment data and validating the data in a scientific manner along with a panel of health experts.

Why was body fat percentage added as a metric?

Excessive body fat is an increasing South African and global epidemic that has been found to be a substantial risk factor in numerous diseases, including diabetes and certain types of cancers. For this reason, body fat percentage is included in the new HHS. Furthermore, a high body fat percentage is associated with numerous other risk factors such as high blood pressure, abnormal cholesterol levels, etc. It is also important to understand that an excessively low body fat percentage can also result in a myriad of health conditions. 

The new HHS provides an indication of whether their body fat is within, or outside acceptable ranges. Body fat percentage will be calculated using waist circumference, weight, height, age and gender, using a scientifically validated equation. You may choose to have your body fat percentage measured using a caliper test at a Biokineticist. 

Why is blood pressure assessed? 

South Africa has one of the highest rates of high blood pressure worldwide, with individuals over the age of 50 having the highest incidence; one in three adults in South Africa suffers from high blood pressure. High blood pressure increases the risk of dying from a stroke by 33%, from congestive heart failure (CHF) by 50% and from renal failure, by 10-15%. 
Normal blood pressure: Systolic blood pressure (top reading) 91-129 mmHg; diastolic blood pressure (bottom reading) 61-80 mmHg.

Why is total cholesterol assessed?

Total cholesterol is assessed randomly, in a non-fasting state. This means that clients can eat before having their total cholesterol tested.
Total cholesterol is the only lipoprotein lipid value that will be taken into consideration in the HHS, except for when HDL is used in the calculation. Since the HHS is not a diagnostic tool, but utilised for mass screening with the aim of identifying and preventing health risk.
Total cholesterol is an indication of atherosclerosis, which is associated with an accumulation of cholesterol in the muscular walls of arteries and is one of the leading causes of CVD in South Africa. This finding is substantiated by the WHO, which indicates that nearly half of the variance in CVD rates is due to differences in blood cholesterol levels. In South Africa, 80% of ‘westernised’ South Africans have an elevated cholesterol level, while the levels of the remaining 20% place them at risk of developing high cholesterol.
Within range total cholesterol: 4.11-5.19 mmol.l-1

Why does cholesterol form part of the HHS?

It is important for us to continue to align ourselves with the broad consensus of leading global health organisations (e.g. American Heart Association). These organisations continue to include cholesterol as a CVD risk factor.

What about HDL? 

High-Density Lipoprotein Cholesterol (HDL) will be an optional addition in the revised HHS calculation. It will only be used if the result is sent to Multiply. Aptly known as the ‘good cholesterol’, high levels of HDL reduces an individual’s risk to develop atherosclerosis.
Within range HDL for males: 1.17 - 2.33 mmol.l-1
Within range HDL for females: 1.30 - 2.33 mmol.l-1


Will a low HDL reading influence my HHS?
Yes, A low / below acceptable HDL reading is seen as just as concerning to us as any hyper (above acceptable and too high)  health measurement and thus this will affect your HHS negatively.  Example:  Total cholesterol is below acceptable and the HDL is below acceptable the HHS is Amber.

What if I'm not satisfied with the HDL reading? 

The latest readings will always replace all existing readings. As such, if a client undergoes another health assessment without an HDL, then their HDL will be deleted automatically and only the latest total cholesterol will be used to calculate the HHS.

Why is glucose assessed? 

Glucose is assessed randomly, in a non-fasting state. This means that clients can eat before doing their glucose test. Research has demonstrated a relationship between diabetes, CVD and individuals suffering from a heart attack or stroke. Individuals with diabetes are also more likely to have certain conditions, or risk factors that increase their probability of having CVD.
Within range random/non-fasting glucose: 3.90-7.8 mmol.l-1

What about HbA1c? 

As an alternative to glucose, a client’s HbA1c result will be used over and above glucose  if the result is sent to Multiply. HbA1c reflects the mean glucose concentration over a specific period (approximately 8-12 weeks, depending on the individual) and provides a superior indication of long-term glycaemic control than blood and urinary glucose determinations.
Within range HbA1c: 4.0-5.6%

Why does smoking status form part of the HHS?

Cigarette smoking is associated with an increased rate of adverse health consequences. There is evidence that cigarette smokers are at an increased risk of dying from CVD compared to non-smokers: the risk for all smokers dying from CVD is increased by about 1.5 to 2.5 times and up to 3.5 times for heavy smokers.

Will vaping/electronic cigarettes/e-cigarettes, pipes, cigars and hubbly-bubbly be considered smoking?

Yes.

Why are the normative ranges for male and female clients sometimes different?

The standard international normative values for HDL are different for males and females. This is because research has found that there are marked gender differences in health risk with increasing age. Men have lower cardio protective benefits when compared to women of the same age. However, with increasing age this gender difference disappears, at which point the incidence of cardiovascular disease becomes a primary cause of mortality and morbidity in males and females.

What if a health professional disagrees with Multiply’s HHS ranges? 

The revised HHS is based on sound scientific research and has undergone extensive expert input and scrutiny. Also, Multiply’s panel of health experts extensively scrutinised normative values. While not all health professionals always agree on scientific principles, it does not detract from the physiological basis and research. 

What does each variable’s category mean?

Below acceptable:  Below the range of the standardised norms.
Acceptable:   Within range of the standardised norms.
Somewhat acceptable:  Above the range of the standardised norms.
Too high:   Far exceeding the range of the standardised norms.

How should the HHS colours be interpreted?

Green: You're on track. All of your cardiovascular disease risk factors are currently under control.
Amber:  There is room for improvement. You should take action to reduce your cardiovascular disease risk factors
Red: You could be doing a lot better. You need to take strong action to reduce your cardiovascular disease risk factors.

Can a person that exercises regularly still have unacceptable values? 

Yes, because physical activity does not improve all health risk markers equally. However, it is important to remember that if you did not participate in physical activity, your measures might have been worse.

What if I am not happy with my estimated body fat percentage? 

If a client is dissatisfied, they can have their body fat percentage tested by undergoing the four skinfold body fat percentage test at any BASA accredited biokineticist, as part of a Fitness Assessment. The cost thereof is for the client and the results will be sent to us, which will influence the client’s HHS.

Why does Multiply not show the body fat percentage?

The equation used by Multiply estimates the range in which a client’s body fat percentage lies and not a specific body fat percentage. 

Will body fat percentage be calculated for a pregnant client?

No. The body fat percentage measurement will be excluded when calculating the HHS and fitness assessment level, including for six months after the pregnancy. A client will be required to supply proof of the continuing pregnancy and/or the birth certificate to the nurse or biokineticist to prove the continuing pregnancy or that they gave birth within the last six months. It is not possible to change a pregnant woman’s HHS or fitness assessment level, if she did not know that she was pregnant at the time of undergoing the health and/or fitness assessment. However, she can repeat the assessment(s) at her own cost.

Will a high cholesterol reading penalise a pregnant client or one that has given birth in the last six months? 

If a client had a normal total cholesterol reading before falling pregnant and it is in the history file for the client, we will accept the history result and it will override the current reading, if high. If there is no total cholesterol reading, normal total cholesterol ranges will be manually loaded for such a client. If a client had unacceptable total cholesterol levels prior to getting pregnant, no exception will be made, as this could carry health risks during the pregnancy. 

Can a HHS and fitness assessment test result change the results of one another?

No.

How many points does a client earn for completing a health assessment? 

The result of a health assessment is a HHS. Based on your HHS, you will earn the following points: 
If you achieve a green HHS, you will earn 100 points.
If you achieve an amber HHS, you will earn 60 points.
If you achieve a red HHS, you will earn 30 points.

How long is a health assessment valid for?

One year, but a client can redo any one of the measurements at any time; it can influence their existing HHS positively or negatively.

How many times a year should a health assessment be done? 

You can do as many health assessments as you like, but would need to pay for every additional assessment. Multiply only requires one health assessment per year. If your HHS improves, you will get additional points.

Do you have to fast before a health assessment? 

No.