The Largest Contributor to the High Prevalence of Type 2 Diabetes? High BMI

The prevalence of type 2 diabetes mellitus (T2DM) in the United States has been rising for decades. A new study suggests that body mass index is the largest contributor to the rising rate of T2DM.

Over the past several decades, type 2 diabetes mellitus (T2DM) has become an increasingly prevalent condition in the United States, imposing a high burden on society in terms of lost work productivity, health deficits, and lost health care dollars.^1,2

Between 1976 and 1980, the prevalence of T2DM nearly doubled, and redoubled again between 1999 and 2004. Over the past 10 years, growth in the prevalence of T2DM has continued to rise, with the most up-to-date data from the 2010 National Health and Nutrition Examination Survey (NHANES) showing the prevalence to be 11.2% in men and 8.7% in women.²

In an analysis of NHANES data on 23,932 participants between 20 and 74 years of age, which was published in the Annals of Internal Medicine, Menke et al identified an age-, race-, body mass index (BMI)—, and ethnicity-adjusted increase in T2DM prevalence, indicating a significant increase in men between 2007 and 2010 (6.2% to 9.6%; P <.001) and a nonsignificant change in women (7.6% to 7.5%; P = 69).²

These results suggest that the increase in T2DM prevalence among men may be due to factors unaccounted for by the investigators’ adjustments for age, race, BMI, and ethnicity. Notably, however, analyzing the contribution of body weight and the prevalence of T2DM, investigators found that BMI was the greatest contributor to the change in T2DM prevalence among men and women.²

In an interview with Healio.com, study authors stated, “The substantial contribution of BMI to the prevalence of T2DM in both men and women supports ongoing public health efforts to address obesity, including developing effective interventions aimed at reducing obesity.”¹

Although high BMI may be a factor in the rising prevalence of T2DM, researchers have documented some positive changes in dietary habits in recent years.³

For instance, in a 2011 study published in the American Journal of Clinical Nutrition, Welsh et al documented positive change in consumption of added sugars in the United States. Between 1999-2000 and 2007-2008, consumption of calories from added sugar decreased from 18.1% of dietary calories to 14.6%, constituting a modest, but statistically significant (P <.001) reduction in caloric intake from simple sugars.³

More positive changes will be required to ameliorate the growth in the prevalence of T2DM in the United States. Educational initiatives, lifestyle changes, and regulatory policies limiting the marketing and consumption of sugar-sweetened beverages, as well as other changes in public health policy, may be useful tools in promoting this societal shift to a healthier America.

References:

1. Healio. Diabetes rates surged along with obesity, but BMI doesn’t explain higher incidence in men. www.healio.com. Published September 2, 2014. Accessed September 4, 2014.

2. Menke A, Rust KF, Fradkin J, Cheng YJ, Cowie CC. Associations between trends in race/ethnicity, aging, and body mass index with diabetes prevalence in the United States: a series of cross-sectional studies. Ann Intern Med. 2014;161(5):328-335.

3. Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States. Am J Clin Nutr. 2011;94(3):726-734.