Research ArticleOriginal Research

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

Arch G. Mainous, Rebecca J. Tanner, Ara Jo and Stephen D. Anton
The Annals of Family Medicine July 2016, 14 (4) 304-310; DOI: https://doi.org/10.1370/afm.1946

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    The prevalence of prediabetes in the United States among adults without diagnosed or undiagnosed diabetes from 1988 to 2012.

    Note: Trend from 1999–2012 age ≥20 years, P <.0001; trend from 1999–2012 age ≥45 years, P <.0001. Vertical bars = 95% CI.

  • Figure 2
    Figure 2

    The prevalence of unhealthy waist circumference in the United States among healthy weight adults without diagnosed or undiagnosed diabetes from 1988 to 2012.

    Note: Trend from 1999–2012 age ≥20 years (P = .34); trend from 1999–1912 age ≥45 years, P = .40. Vertical bars = 95% CI.

  • Figure 3
    Figure 3

    The prevalence of unhealthy waist-to-height ratio in the United States among healthy weight adults without diagnosed or undiagnosed diabetes from 1988 to 2012.

    Note: Trend from 1999–2012 ages ≥20 years, P =.007; trend from 1999–2012 ages ≥45, years P = .007. Vertical bars = 95% CI.

Tables

  • Table 1

    Weighted Total Prediabetes Prevalence, % (95% CI) of Adults Aged 20 Years or Older in the US Population Using Hemoglobin A1c Levels to Define Diabetes; NHANES 1988–1994 and 1999–2012

    Characteristic1988–1994 (n = 5,667)1999–2000 (n = 1,265)2001–2002 (n = 1,382)2003–2004 (n = 1,319)2005–2006 (n = 1,272)2007–2008 (n = 1,335)2009–2010 (n = 1,415)2011–2012 (n = 1,347)
    Prediabetes cases, No. (weighted total No.)917 (7,086,925)107 (3,318,187)119 (3,375,785)126 (3,963,758)138 (4,847,946)265 (9,029,950)292 (10,239,137)292 (10,869,265)
    Prevalence of prediabetes10.2 (8.8–11.7)5.6 (3.7–8.4)5.9 (4.9–6.9)6.8 (5.4–8.5)8.3 (6.2–10.9)15.5 (13.0–18.4)17.7 (15.6–20.1)18.5 (15.1–22.4)
    Age, y
     20–444.2 (3.2–5.4)1.3 (0.5–3.3)2.7 (1.5–4.7)0.8 (0.4–1.8)1.9 (1.1–3.4)4.9 (3.5–6.8)5.1 (4.1–6.4)6.8 (4.7–9.7)
     45–6416.5 (14.2–19.0)9.9 (5.2–18.0)7.7 (5.5–10.8)11.0 (7.6–15.5)11.9 (9.0–15.6)22.8 (18.0–28.3)30.4 (24.0–37.7)26.8 (20.3–34.6)
     ≥6530.6 (26.9–34.6)17.6 (12.7–23.9)18.3 (13.4–24.5)23.7 (18.5–29.8)25.5 (20.3–31.5)40.6 (32.7–48.9)42.6 (37.2–48.2)44.9 (36.1–54.1)
    Sex
     Male12.7 (11.0–14.6)6.6 (3.9–10.8)6.90 (5.3–8.9)7.7 (6.0–9.9)9.0 (6.3–12.7)16.0 (12.8–19.8)17.1 (14.0–20.8)17.7 (13.0–23.6)
     Female8.18 (6.7–10.0)4.7 (2.7–8.1)5.1 (3.6–7.2)6.1 (4.2–8.7)7.8 (5.7–10.6)15.2 (11.8–19.4)18.1 (15.5–21.2)19.1 (15.3–23.6)
    Race
     Non-Hispanic white8.4 (6.9–10.2)4.7 (2.6–8.4)5.1 (3.8–6.8)5.4 (4.0–7.3)6.7 (4.2–10.8)14.8 (11.7–18.5)16.4 (13.8–19.3)18.3 (14.2–23.1)
     Non-Hispanic Black20.4 (18.4–22.6)9.1 (6.0–13.4)10.2 (6.6–15.4)10.8 (7.1–16.1)19.8 (13.4–28.4)25.6 (17.8–35.2)22.7 (16.0–31.1)24.6 (17.6–33.2)
     Mexican American9.9 (8.1–12.1)4.3 (2.2–8.1)3.6 (1.5–8.5)3.8 (2.0–7.0)6.1 (3.0–12.1)12.2 (8.4–17.3)13.5 (8.8–20.0)16.8 (10.2–26.5)
     Other16.4 (11.0–23.6)8.7 (4.2–17.2)9.8 (4.5–19.8)14.8 (9.1–23.3)12.0 (7.1–19.6)14.8 (8.7–24.1)23.2 (17.8–30.0)17.2 (13.2–22.1)
    Poverty to income ratio (PIR)
     Poverty (PIR <1.0)14.5 (10.9–18.9)7.3 (4.5–11.6)5.1 (3.2–8.0)7.8 (5.3–11.3)9.8 (6.3–15.0)15.2 (10.5–21.5)18.4 (13.8–24.2)16.3 (6.8–34.3)
     Not in poverty (PIR ≥1.0)9.3 (8.1–10.7)5.5 (3.5–8.4)5.9 (4.7–7.4)6.7 (5.2–8.6)7.6 (5.4–10.4)14.9 (12.4–17.8)17.0 (14.6–19.7)18.1 (15.2–21.4)
    Health insurance
     Private9.1 (7.7–10.7)4.9 (2.8–8.3)4.6 (3.6–5.8)6.7 (5.1–8.7)6.9 (5.0–9.6)14.6 (11.8–17.9)16.2 (13.6–19.3)17.5 (13.7–22.1)
     Public21.5 (17.3–26.5)13.3 (7.7–22.1)13.5 (9.6–18.7)11.5 (7.3–17.7)17.5 (13.6–22.2)25.5 (19.4–32.6)24.3 (19.5–29.8)27.9 (20.2–37.0)
     None8.3 (5.0–13.6)4.5 (3.2–6.2)6.7 (4.7–9.4)3.7 (1.9–7.0)6.5 (3.5–11.6)12.4 (8.3–18.3)18.6 (13.8–24.5)13.0 (9.6–17.4)
    Education
     <High school17.9 (15.4–20.7)10.6 (7.5–14.9)8.6 (5.8–12.6)9.8 (7.1–13.5)14.6 (10.1–20.7)21.9 (16.6–28.3)25.6 (21.2–30.4)31.6 (21.4–43.9)
     High school10.0 (7.8–12.8)6.4 (3.5–11.6)8.1 (5.7–11.2)8.0 (5.7–11.0)10.7 (6.5–17.3)23.4 (17.6–30.4)16.3 (11.2–23.2)23.1 (16.3–31.7)
     Some college/college degree6.7 (5.6–8.0)3.3 (1.7–6.4)4.2 (3.0–5.9)5.2 (3.6–7.6)5.7 (4.1–7.9)10.8 (8.1–14.3)16.3 (14.5–18.3)14.9 (11.3–19.3)
    First-degree relative with diabetes
     Family history10.0 (8.5–11.8)7.1 (4.4–11.3)6.5 (5.1–8.3)7.0 (4.8–10.3)10.1 (6.7–14.8)21.0 (17.1–25.5)18.1 (14.8–21.9)21.2 (14.4–30.0)
     No family history10.4 (8.7–12.4)4.6 (2.9–7.1)5.2 (4.0–6.8)6.9 (5.0–9.4)7.5 (5.4–10.4)13.2 (10.5–16.4)17.6 (15.3–20.1)17.6 (14.5–21.2)

    • NHANES = National Health and Nutritional Examination Survey.

  • Table 2

    Logistic Regressions Examining the Relation of Abdominal Obesity to Risk of Prediabetes in 2011–2012, NHANES

    CharacteristicUnadjusted OR (95% CI)Adjusted OR (95% CI)a
    Aged ≥20 years
     Unhealthy waist circumference2.00 (0.76–5.28)1.10 (0.45–2.66)
     Unhealthy waist-to-height ratio2.34 (1.39–3.95)1.06 (0.65–1.73)
    Age ≥45 years
     Unhealthy waist circumference1.27 (0.46–3.54)1.00 (0.42–2.37)
     Unhealthy waist-to-height ratio1.40 (0.90–2.18)1.04 (0.65–1.66)

    • NHANES = National Health and Nutritional Examination Survey; OR = odds ratio.

    • ↵a Controls for age, sex, race/ethnicity, education, poverty-to-income ratio, health insurance, and presence of a first-degree relative with diabetes.

Additional Files

  • The Article in Brief

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

    Arch G. Mainous III , and colleagues

    Background Detection and treatment of prediabetes is a fundamental strategy in preventing diabetes. Conventional thinking suggests that the obesity epidemic is driving the epidemic in diabetes, and that abdominal obesity is a particularly good marker of those at risk. This study examines the prevalence of prediabetes and abdominal obesity among healthy weight adults.

    What This Study Found One-third of non-obese people have prediabetes. In the first study to examine trends in prediabetes prevalence among individuals with a body mass index in the healthy range, researchers find the prevalence of prediabetes and abdominal obesity has increased markedly since 1988. The prevalence of prediabetes in healthy-weight adults aged 20 years and older without diagnosed or undiagnosed diabetes increased from 10 percent in 1988-1994 to 19 percent in 2012. Among people aged 45 years and older, the prevalence of prediabetes increased from 22 percent to 33 percent. The percentage of adults aged 20 years and older with an unhealthy waist circumference increased from 5 percent in 1988-1994 to 8 percent in 2012, and the percentage with an unhealthy waist-to-height ratio increased from 27 percent in 1988-1994 to 34 percent in 2012. Based on further analyses, abdominal obesity does not appear to be the primary cause of the increase in prediabetes.

    Implications

    • These findings are an important wake-up call. The authors call for additional research to determine the primary cause of the rise and alternative ways to detect prediabetes in primary care among healthy weight adults.
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