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

Abstract

Purpose: Trends in sedentary lifestyle may have influenced adult body composition and metabolic health among individuals at presumably healthy weights. This study examines the nationally representative prevalence of prediabetes and abdominal obesity among healthy-weight adults in 1988 through 2012.

Methods: We analyzed the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES for the years 1999 to 2012, focusing on adults aged 20 years and older who have a body mass index (BMI) of 18.5 to 24.99 and do not have diabetes, either diagnosed or undiagnosed. We defined prediabetes using glycated hemoglobin (HbA1c) level ranges from 5.7% to 6.4%, as specified by the American Diabetes Association. Abdominal obesity was measured by waist circumference and waist-to-height ratio.

Results: The prevalence of prediabetes among healthy-weight adults, aged 20 years and older and without diagnosed or undiagnosed diabetes, increased from 10.2% in 1988-1994 to 18.5% in 2012. Among individuals aged 45 years and older, the prevalence of prediabetes increased from 22.0% to 33.1%. The percentage of adults aged 20 years and older with an unhealthy waist circumference increased from 5.6% in 1988-1994 to 7.6% in 2012. The percentage of individuals with an unhealthy waist-to-height ratio increased from 27.2% in 1988-1994 to 33.7% in 2012. Adjusted models found that measures of abdominal obesity were not independent predictors of prediabetes among adults with a healthy BMI.

Conclusions: Among individuals within a healthy BMI range, the prevalence of prediabetes and abdominal obesity has substantially increased. Abdominal obesity does not appear to be the primary cause of the increase.

Keywords: diabetes type II; hyperglycemia; prediabetes; prediabetic state; prevalence; prevention.

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

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

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.