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C H A P T E R 3

Epidemiology of
Type 2 Diabetes and
Obesity in Children

EVIDENCE FOR AN EPIDEMIC OF TYPE 2
DIABETES IN CHILDREN (TABLES 9–11)

North America

In the Pima Indian population, in which 50% of adults have type 2 diabetes

in 1979, prevalence of type 2 diabetes was

1% (9 of 1,000) of those age 15–24 years

nil in those younger than 15 years (1)

by the 1990s, type 2 diabetes prevalence was

5% of those 15–19 years old (51 of 1,000)

2.2% of those 10–14 years old (22 of 1,000) (2)

First Nation population in Canada: The frequency of type 2 diabetes in children and youth was comparable to that of type 1 diabetes in Caucasians (3)

Review of 1,027 consecutive records of children 0–19 years old diagnosed with diabetes in Cincinnati, Ohio found (4)

2–4% diagnosed with type 2 diabetes from 1982 to 1992 (stable for over 20 years; Knowles [5] reported that ∼3.5% of patients in this same clinic had type 2 diabetes in 1971)

16% diagnosed with type 2 diabetes in 1994

33% of newly diagnosed patients age 10–19 years with type 2 diabetes in 1994

Table 9. Estimates of the Frequency of Type 2 Diabetes in Children and Adolescents

estimated age-specific incidence to be 7.2 per 100,000,

one-half the incidence rate for type 1 diabetes in the childhood population

a tenfold increase since 1982

Cincinnati (4) and Arkansas (6): African Americans accounted for 70–75% of pediatric type 2 diabetes patients.

Mexican Americans (7): One-third of diabetes patients under the age of 17 years have type 2 diabetes.

In a study of 682 patients age 5–19 years diagnosed between January 1, 1994, and December 31, 1998, at the three university diabetes centers in Florida (8)

86% were considered to have type 1 diabetes and 14% type 2 diabetes

47% of patients with type 1 diabetes and 63% of patients with type 2 diabetes were female

only 46% of those with type 2 diabetes were African American, 22% were Hispanic, and the rest were non-Hispanic Caucasian

the proportion of newly diagnosed patients with diabetes who had type 2 diabetes increased from 8.7% in 1994 to 19% in 1998

Table 10. Type 2 Diabetes in Children and Adolescents Outside of North America

Libyan Arabs (9)

Age-specific annual incidence

6/100,000 for age 15–19 years

26/100,000 for age 20–24 years

100/100,000 for age 25–29 years

240/100,000 for age 30–34 years

Overall (age 0–34)

>2 times the incidence of type 1 diabetes in males

>4 times the incidence of type 1 diabetes in females

Hong Kong Chinese (10)

Accounts for >90% of young onset diabetes in Chinese

Strongly familial

Associated with obesity

Taiwan Chinese (11)

From 1992 to 1999, annual urine screening of schoolchildren followed by repeat test and fasting blood test for glycemia, as indicated

Nearly 3 million students tested each semester

Incidence rates

8.3 per 100,000 among boys and 12.0 per 100,000 among girls

significant increase from 6th grade for boys and 4th grade for girls, with peak rates

14.7 per 100,000 in 8th grade for boys

19.0 per 100,000 in 6th grade for girls

Japanese (12)

Type 1 diabetes relatively rare as in Chinese

Annual urine testing of schoolchildren within Tokyo prefecture since 1975, followed by oral glucose tolerance testing as indicated

∼4 fold increased incidence of type 2 diabetes between 1976 and 1995

increased incidence of type 2 diabetes paralleled by increasing obesity rates

Bangladeshi (13)

Population sampling of ∼7000 suburban residents including ∼300 age 15–20 years

Type 2 diabetes prevalence 0.6/1000

Type 2 diabetes associated with increased BMI

Australian Aborigines (14)

74 children and adolescents followed for 5 years

Increase in prevalence of overweight from 2.7% to 17.6% over the 5 years

At end of study (mean age 18.5 years) 8% with impaired glucose tolerance, 2.7% with type 2 diabetes and 22% with elevated cholesterol

New Zealand Maoris (15)

5% of 1,052 diabetes patients diagnosed before age 30, of which 55% were type 2

Micro-albuminuria more common in type 2 diabetes (62%) vs. type 1 diabetes (18%)

86% of patients with type 2 diabetes overweight vs. 44% of those with type 1 diabetes

Female:male 1.5:1

THE EPIDEMIC OF OBESITY

United States

Obesity, defined in adults as a BMI ≥30 kg/m², doubled in frequency in the adult population in the last decade of the 20th century (16).

Obesity prevalence in 2000 was ∼20% of adults (16):

18.5% of Caucasians

29.3% of African Americans

23.4% of Hispanics

The National Health and Nutrition Examination Survey (NHANES) III conducted between 1988 and 1994 described a doubling in prevalence of childhood obesity since the 1980s (17).

NHANES III update of 1999 (18) found BMI >95% for age and sex, varying with ethnicity, in

11–18% of boys 6–11 years old

10–17% of girls 6–11 years old

11–14% of boys 12–19 years old

10–17% of girls 12–19 years old

The Bogalusa Heart Study, a 20-year (1973–1994), biracial, community-based study in Louisiana of 11,564 individuals 5–24 years old (19):

Mean weight increased 0.2 kg/year, and skinfold thickness increased.

The frequency of overweight doubled.

Overweight (>85th percentile BMI) increased from 15 to 30%.

Obesity (>95th percentile BMI) increased from 5 to 11% in those 5–14 years old and from 5 to 15% in those age 15–17 years old.

Increases in the second 10 years of the study were 50% greater than those in the first 10 years.

The National Longitudinal Survey of Youth, a prospective cohort study of 8,270 children age 4–12 years (22):

There was a significant increase in “overweight” (>95th percentile of BMI for age and sex) and risk of overweight (85th–95th percentile of BMI).

Prevalence rates in 1998 (Fig. 1) were

BMI >85th percentile: African Americans 38.4%, Hispanics 37.9%, Caucasians 25.8%

BMI >95th percentile: African Americans 21.5%, Hispanics 21.8%, Caucasians 12.3%

International

Table 11. Obesity Trends in Children and Youth Outside of the United States

Russia—1992 (20)

∼7000 patients age 6–18 years examined

6% obese (>95th percentile BMI), 10% overweight (85th–95th percentile) using U.S. BMI reference data

China—1993 (20)

∼3000 patients age 6–18 years examined

3.6% obese, 3.4% overweight (as defined above)

United Kingdom—1996 (21)

22% overweight, 10% obese at age 6 years

31% overweight, 17% obese at age 15 years

Europe (21): highest rates of childhood obesity in Eastern Europe (particularly Hungary), and Spain, Italy, and Greece

FIGURE 1. Prevalence rates of BMIs >95th percentile. Weighted sample. In each graph, the dashed line and significance value represent linearized trends for each subgroup after adjustment for the child’s age. , BMI >85th percentile; , BMI >95th percentile. From U.S. Department of Labor, Bureau of Labor Statistics (22).

REFERENCES

1. Savage PJ, Bennett PH, Senter RG, Miller M: High prevalence of diabetes in young Pima Indians. Diabetes 28:937–942, 1979

2. Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ: Increasing prevalence of type 2 diabetes in American Indian children. Diabetologia