E2 ModeratePreliminaryPEM unclearCross-SectionalPeer-reviewedReviewed
Traditional Chinese medicine and new concepts of predictive, preventive and personalized medicine in diagnosis and treatment of suboptimal health.
Wang, Wei, Russell, Alyce, Yan, Yuxiang et al. · The EPMA journal · 2014 · DOI
Quick Summary
This study looked at how to identify people in the early stages of health problems before they develop into serious diseases. The researchers created a simple 25-question survey to measure 'suboptimal health'—a state where people feel unwell with fatigue and other complaints but don't have a clear diagnosis. They tested this survey with over 3,400 people in China and found that answers to the survey were connected to blood pressure, blood sugar, and cholesterol levels.
Why It Matters
ME/CFS patients often struggle with a lack of objective diagnostic tests and may be categorized as having 'suboptimal health' before receiving a diagnosis. This study proposes a systematic approach to identify and monitor people with unexplained fatigue and symptom clusters, which could help researchers better understand the early stages of conditions like ME/CFS and potentially enable earlier intervention.
Observed Findings
- SHSQ-25 scores correlated with systolic and diastolic blood pressure in both men and women
- Correlations found between SHS and plasma glucose, total cholesterol, and HDL cholesterol in men
- Correlations found between SHS and triglycerides and HDL cholesterol in women
- Sex differences observed in which cardiometabolic markers associated with SHS scores
Inferred Conclusions
- SHSQ-25 is a valid and reliable self-rated instrument for identifying and measuring suboptimal health status in populations with ambiguous complaints
- Suboptimal health status is associated with multiple cardiometabolic risk factors, suggesting it may represent an intermediate disease state
- SHS assessment could support a paradigm shift from reactive to predictive medicine through patient stratification and risk monitoring
Remaining Questions
- Does suboptimal health status measured by SHSQ-25 prospectively predict development of ME/CFS or other chronic diseases?
- How does suboptimal health status differ mechanistically from early-stage ME/CFS or post-viral fatigue syndrome?
- Can SHSQ-25-based interventions prevent progression to diagnosed chronic disease, and what treatments are most effective for people identified through this screening?
What This Study Does Not Prove
This study does not prove that the SHSQ-25 survey can predict who will develop ME/CFS or other chronic diseases, nor does it establish causation between suboptimal health status and disease onset. The cross-sectional design captures only a single time point and cannot demonstrate whether the observed correlations with cardiometabolic factors precede or follow the development of fatigue symptoms.
Tags
Symptom:FatigueCognitive Dysfunction
Biomarker:Blood Biomarker
Method Flag:Weak Case DefinitionExploratory OnlyMixed Cohort
Metadata
- DOI
- 10.1186/1878-5085-5-4
- PMID
- 24521056
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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