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Prediabetes, abdominal obesity on the rise among those with healthy BMI

Among patients within the healthy BMI range, rates of prediabetes and abdominal obesity have substantially increased from 1988 to 2012, according to data published in the Annals of Family Medicine.

“Current recommendations for prediabetes screening by the American Diabetes Association focus nearly exclusively on adults who are overweight or obese as defined by [BMI] until the patient meets the age-oriented screening at 45 years,” Arch G. Mainous III, PhD, of the department of health services research, management and policy at the University of Florida, in Gainesville, and colleagues wrote. “Further, the recently released recommendation from the U.S. Preventive Services Task Force regarding screening for abnormal glucose levels and type 2 diabetes limits screening to individuals who are overweight or obese. This focus on obese or overweight individuals, however, may lead to missed opportunities for investigation of undetected disease in healthy-weight individuals.”

To analyze the rate of prediabetes and abdominal obesity among adults who are of healthy weight, the researchers drew data from the National Health and Nutrition Examination Survey (NHANES) for the years 1988 to 1994 and 1999 to 2012. Researchers focused on individuals aged 20 years and older who had a BMI of 18.5 to 24.99 and did not have diagnosed or undiagnosed diabetes.

Prediabetes was diagnosed as using glycated hemoglobin level ranges from 5.7% to 6.4%, as specified by the American Diabetes Association. The researchers measured abdominal obesity by waist circumference and waist-to-height ratio.

According to the researchers, the rate of prediabetes among healthy-weight adults aged 20 years and older, without diagnosed or undiagnosed diabetes, increased from 10.2% in 1988 to 1994, to 18.5% in 2012. In addition, among those aged 45 years and older, the prediabetes rate increased from 22% to 33.1%. Meanwhile, the rate of adults aged 20 years and older with an unhealthy waist circumference increased from 5.6% in 1998 to 1994, to 7.6% in 2012, and the prevalence of adults with an unhealthy waist-to-height ratio increased from 27.2% to 33.7%. Adjusted models revealed that measures of abdominal obesity were not independent predictors of prediabetes among adults with healthy BMI.

“This nationally representative study provides evidence of a substantial proportion of individuals with a healthy weight BMI having prediabetes,” Mainous and colleagues wrote. “Moreover, it indicates a secular increase in prediabetes in the population designated as a healthy weight. Diabetes prevention efforts will benefit from future research focused on determining the primary cause of this rise and efficient ways to detect prediabetes in primary care among healthy-weight adults.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.