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Prediabetes Increased Among U.S. Youths From 1999 Through 2018 Regardless Of BMI

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By OPEN MINDS Circle

The prevalence of prediabetes among youth ages 12 to 19 in the United States increased from 11.6% in 1999 to 28.2% in 2018. The increase in prediabetes occurred across groups regardless of body mass index (BMI), and in each population demographic and socio-economic subgroup measured. Parental education level was not protective against the increase in prediabetes, but family income had a slight relationship to prevalence of prediabetes among youth.

Prediabetes is defined as having no recorded diagnosis of diabetes, but having a hemoglobin A1c level of 5.7% to 6.4%, or a fasting plasma glucose level of 100 mg/dL to 125 mg/dL. Diabetes is defined as fasting glucose level above 125 mg/dL.

The prevalence of prediabetes increased among youth considered underweight, normal weight, overweight, or obese. Their weight status was based on their BMI. Over the study period, the percentage of youth in each BMI category changed.

  • Among youth considered underweight or normal weight, prevalence of prediabetes increased from 9.4% to 24.3%. The percentage of youth with an underweight or normal weight BMI declined from 70.3% of youth to 60.1% of youth.
  • Among overweight youth, prevalence of prediabetes increased from 15.3% to 27.5%. The percentage of youth with overweight increased from 13.3% to 18.4%.
  • Among youth with obesity, prevalence of prediabetes increased from 18.2% to 40.4%. The percentage of youth with obesity increased from 16.4% to 21.5%.

The increase in prediabetes occurred for females and males, and for Hispanic, Black, and white youth. Among females, the prevalence of prediabetes increased from 7.1% to 19.6%, and among males from 15.8% to 36.4%. Among Hispanic youth, prevalence increased from 13.4% to 28.6%. Among Black youth, prevalence increased from 11.7% to 32.3%. Among white youth, prevalence increased from 11.5% to 26.8%.

Greater parental education levels were not protective against the increase in prediabetes.

  • Among children of parents with less than a high school education, prediabetes prevalence increased from 15.6% to 29.1%.
  • Among children of parents who completed high school, prediabetes prevalence increased from 10.0% to 29.2%.
  • Among children of parents with some college or post-secondary degrees, prediabetes prevalence increased from 11.1% to 26.8%.

Family income level had a slight relationship to the prevalence of prediabetes among youth.

  • Among youth in families with income below 300% of the federal poverty level, the prevalence of prediabetes tripled. Among those below 130% FPL, prediabetes increased from 12.5% to 31.2%.
  • Among those at 130% up to 299% FPL, prediabetes increased from 9.3% to 30.0%.
  • Among youth in families with income above 300% FPL, prevalence of prediabetes increased from 11.8% to 24.5%.

The effect of food security on prediabetes prevalence was complex. Prediabetes increased for households with very low, low, marginal, or full food security.

  • Among youth in households with very low food security, the prevalence of prediabetes rose from 18.4% to 26.3%. Very low food security is defined as reports of multiple indications of disrupted eating patterns and reduced food intake.
  • Among youth in households with low food security, the prevalence of prediabetes increased from 12.0% to 29.6%. Low food security is defined as reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.
  • Among youth in households with marginal food security, the prevalence of prediabetes increased from 11.4% to 45.5%. Marginal food security is defined as one or two reported indications, such as anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake.
  • Among youth in households with full food security, the prevalence of prediabetes increased from 10.8% to 25.6%. Full food security is defined as no reported indications of food-access problems or limitations.

These findings were reported in “Trends in Prediabetes Among Youths in the US From 1999 Through 2018” by Junting Liu, MS; Yan Li, Ph.D.; Donglan Zhang, Ph.D.; and colleagues. The researchers analyzed data from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from the 1999-2000 cycle through the 2017-2018 cycle. NHANES is a series of cross-sectional surveys using a complex, multistage probability design to sample the civilian, non-institutionalized population. As part of the survey, blood samples are obtained. To create sufficiently large sample sizes of youth ages 12 to 19 for the analysis, the researchers combined every two cycles. In total, data for 6,598 youth were included in the analysis.

For more information, contact: Junxiu Liu, Ph.D., Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029; Email: junxiu.liu@mountsinai.org