Get started with essential8

Overview

essential8 computes component and composite Life’s Essential 8 (LE8) cardiovascular health scores. The current implementation scores adults aged 20 years or older using the American Heart Association’s 2022 definition. Pediatric scoring is not yet available.

This vignette shows the basic complete-data workflow. See ?score_le8 for the full input contract and scoring details.

Create an adult data frame

Supply one row per person. The example below uses base R and includes two adults with raw responses to the 16-item Mediterranean Eating Pattern for Americans (MEPA) screener. It also demonstrates both possible BMI profiles and both possible glucose measures.

library(essential8)

adult_data <- data.frame(
  id = c("patient_1", "patient_2"),
  age = c(42, 61),
  sex = c("female", "male"),
  # Daily servings
  olive_oil = c(2, 1),
  green_leafy_vegetables = c(1, 0.5),
  other_vegetables = c(2, 1),
  whole_grains = c(2, 1),
  # Weekly servings
  berries = c(3, 1),
  other_fruit = c(5, 2),
  meat = c(2, 5),
  fish = c(3, 1),
  chicken = c(2, 4),
  cheese = c(1, 4),
  butter_cream = c(1, 5),
  beans = c(3, 1),
  sweets_and_pastries = c(1, 5),
  nuts = c(4, 1),
  fast_food = c(0, 2),
  alcohol = c(4, 0),
  moderate_activity_minutes = c(100, 60),
  vigorous_activity_minutes = c(25, 0),
  smoking_status = c("never", "former"),
  years_since_quit = c(0, 6),
  current_inhaled_nds = c(FALSE, FALSE),
  secondhand_smoke_home = c(FALSE, FALSE),
  sleep_hours = c(7.5, 6.5),
  bmi = c(24.2, 24.0),
  bmi_profile = c("general", "asian_pacific"),
  non_hdl_cholesterol = c(125, 145),
  lipid_lowering_treatment = c(FALSE, TRUE),
  diabetes = c(FALSE, FALSE),
  glucose_measure = c("fasting_glucose", "hba1c"),
  glucose_value = c(95, 6.0),
  systolic_bp = c(118, 132),
  diastolic_bp = c(76, 84),
  antihypertensive_treatment = c(FALSE, TRUE)
)

Compute LE8 scores

Pass the data frame to score_le8(). The returned data frame retains the input columns and appends the derived activity measure, eight component scores, composite score, and category.

scored <- score_le8(adult_data, diet_method = "mepa")

scored[c(
  "id",
  "mepa_total",
  "le8_diet_score",
  "physical_activity_moderate_equivalent_minutes",
  "le8_composite_score",
  "le8_category"
)]
#>          id mepa_total le8_diet_score
#> 1 patient_1         14             80
#> 2 patient_2          4             25
#>   physical_activity_moderate_equivalent_minutes le8_composite_score
#> 1                                           150              97.500
#> 2                                            60              54.375
#>   le8_category
#> 1         high
#> 2     moderate

Each vigorous activity minute counts as two moderate activity minutes and is recorded as physical_activity_moderate_equivalent_minutes. The le8_composite_score is the mean of the eight component scores. Categories are "low" below 50, "moderate" from 50 to less than 80, and "high" at 80 or higher.

The component scores are available for analysis and quality checks:

component_columns <- setdiff(
  grep("^le8_.*_score$", names(scored), value = TRUE),
  "le8_composite_score"
)

scored[c("id", component_columns)]
#>          id le8_diet_score le8_physical_activity_score le8_nicotine_score
#> 1 patient_1             80                         100                100
#> 2 patient_2             25                          60                 75
#>   le8_sleep_score le8_bmi_score le8_blood_lipids_score le8_blood_glucose_score
#> 1             100           100                    100                     100
#> 2              70            75                     40                      60
#>   le8_blood_pressure_score
#> 1                      100
#> 2                       30

Understand the MEPA inputs

The MEPA response columns use the 16 screener-item labels in snake case. The column names should reflect as seen below, but you can map custom columns using mepa_columns = c().

olive_oil, green_leafy_vegetables, other_vegetables, and whole_grains are servings per day.
berries, other_fruit, meat, fish, chicken, cheese, butter_cream, beans, sweets_and_pastries, nuts, and alcohol are servings per week.
fast_food is the number of times per week that meals are consumed from fast-food restaurants.

The screener defines meat as red meat, hamburger, bacon, or sausage; fish includes fish, shellfish, or seafood; and cheese means full-fat or regular cheese or cream cheese.

score_le8() evaluates each criterion and returns their sum as mepa_total so that the derived diet input can be audited. The default MEPA sex field is sex. If sex is absent, a field named female is recognized automatically; map any other name with, for example, mepa_columns = c(sex = "reported_sex"). Values are trimmed and matched case-insensitively as "m"/"f" or "male"/"female". Numeric or character 0/1 values are also accepted, where 0 is male and 1 is female.

Choose other input methods explicitly

The diet_method argument defaults to "mepa". If a source data set contains both MEPA and percentile inputs, split the rows into separate data frames and call score_le8() separately for each method.

For diet_method = "mepa", diet_value must be absent or contain only missing values.
For diet_method = "percentile", diet_value is required; MEPA columns are ignored. Supply a DASH or HEI-2015 percentile from 1 to 100, calculated against the relevant reference population before calling score_le8().
Set bmi_profile to either "general" or "asian_pacific". The function does not infer a BMI profile from race or ethnicity.
Set glucose_measure to "fasting_glucose" for a value in mg/dL or "hba1c" for a percentage. Diagnosed diabetes requires HbA1c for scoring.

The percentile workflow is executable without removing the unused MEPA columns:

percentile_data <- adult_data[1, , drop = FALSE]
percentile_data$diet_value <- 95
percentile_scores <- score_le8(
  percentile_data,
  diet_method = "percentile"
)
percentile_scores[
  c("diet_value", "le8_diet_score", "le8_composite_score")
]
#>   diet_value le8_diet_score le8_composite_score
#> 1         95            100                 100

Three optional, caller-adjudicated flags control clinical-judgment adjustments: apply_lean_muscular_bmi_override, apply_sleep_apnea_penalty, and apply_prediabetes_metformin_penalty. When these columns are absent, their adjustments are not applied.

Complete and source-defined inputs

The current implementation requires complete, finite values for every required input. It does not impute missing data, convert units, or round raw measurements before scoring.

score_le8() also rejects combinations for which the AHA source does not define a score. Examples include an underweight BMI that requires clinical judgment, a diagnostic-range glucose value paired with no diabetes diagnosis, and simultaneous current combustible smoking and inhaled nicotine-delivery-system use. Reconcile these records before scoring.