Prevalence of Prediabetes and Abdominal Obesity Among Healthy-Weight Adults: 18-Year Trend

Mainous, Tanner, Jo and Anton, in their study of the prevalence of prediabetes among healthy-weight adults, point out that the precursor condition signaling insulin resistance that normally leads to Type II diabetes within 10 years has become surprisingly common.(1) Fully 18.5% of a nationally representative sample surveyed in the 2012 National Health and Nutrition Examination Survey (NHANES) tested within the Hgb A1c prediabetic range: a huge increase from 10.2% reported in the 1988-1994 survey. Tragically, millions of prediabetics, estimated to comprise 38% of the general US adult population, progress to full disease every year, adding to the growing, nation-wide, diabetes epidemic.(2)

Clearly, something very bad is happening. The authors speculate that increasing "trends in sedentary lifestyle" could, in part, be responsible. This however is contradicted by the fact that sedentary lifestyle in the US is not increasing.(3) Moreover, one of the two references the authors cite in support of their sedentary lifestyle hypothesis, instead disputes it, stating that the data they relied upon was "incorrectly interpreted as providing evidence of an increase in physical inactivity rates."(4)

The more reasonable hypothesis, one that is now widely acknowledged, is that exploding rates of diabetes and prediabetes are strongly linked to the increased consumption of sugar in the US diet, now approximately 100 pounds per person per year.(5) Of particular importance is the fact that approximately one third of adults in the US drink soda or other sugar sweetened beverages (SSB) on a daily basis.(6)

In San Antonio, over a two year period of intense obesity prevention campaigning, emphasizing both increasing physical activity and better nutrition, we realized an 18% decline in adult obesity that was paralleled by a similar decline in daily soda consumption.(7) The tight relationship between obesity, the leading risk factor for diabetes, and soda drinking calls for investigating the role SSBs play in prediabetes, including healthy-weight prediabetics.

Thomas Schlenker MD, MPH Adjunct Professor Department of Family and Community Medicine University of Texas Health Science Center San Antonio

REFERENCES

1. Mainous AG, Tanner RJ, Jo A, Anton SD. Prevalence of Prediabetes and Abdominal Obesity Among Health Weight Adults: 18-Year Trend. Ann Fam Med. 2016;14:304-310 2. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021-1029. doi:10.1001/jama.2015.10029 3. Moore, L.V., Harris, C.D., Carlson, S.A., Kruger, J., and Fulton, J.E. Trends in no leisure-time physical activity--United States, 1988- 2010. Res Q Exerc Sport. 2012; 83: 587-591 4. Bassett DR, Lee IM. Trends in physical inactivity. Am J Med. 2015; 128(5):e21 5. Sugar Consumption in the US Diet between 1822-2005. (http://onlinestatbook.com/2/case_studies/sugar.html) 6. Prevalence of Sugar-Sweetened Beverage Intake Among Adults. (http://www.cdc.gov/mmwr/volumes/65/wr/mm6507a1.htm?s_cid=mm6507a1_e) 7. San Antonio Metropolitan Health District, unpublished data

Competing interests: None declared