Insulin Resistance and Cardiometabolic Risk Profile Among Non-Diabetic American Young Adults: Insights from NHANES.

Abstract

BACKGROUND\nThe burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated the 1) prevalence and trends of IR and cardiometabolic risk factors and, 2) assessed the association between measures of adiposity and IR among adults aged 18-44 years without diabetes and preexisting cardiovascular disease.\n\n\nMETHODS\nCross-sectional survey data from six consecutive National Health and Nutrition Examination Survey (2007-2008 to 2017-2018) cycles were analyzed. IR was defined by the homeostatic model assessment for IR (HOMA-IR) of ≥2.5. The temporal trends of IR, cardiometabolic risk factors, and the relationship between IR and measures of adiposity were assessed using multivariable-adjusted regression models.\n\n\nRESULTS\nAmong 6,247 young adults aged 18-44 years, the prevalence of IR was 44.8% (95% CI: 42.0-47.6%) in 2007-2010 and 40.3% (95% CI: 36.4-44.2%) in 2015-2018 (Ptrend=0.07). There was a modest association of HOMA-IR with higher body mass index (BMI), waist circumference, total lean fat mass, and total and localized fat mass (all p<0.001). Participants with IR had a higher prevalence of hypertension (31.3% [95% CI: 29.2-33.5%] vs. 14.7% [95% CI: 13.2-16.2%]), hypercholesterolemia (16.0% [95% CI: 12.4-19.5%] vs. 7.0% [95% CI: 5.8-8.5%]), obesity (56.6% [95% CI: 53.9-59.3%] vs. 14.7% [95%CI: 13.0-16.5%]) and poor physical activity levels (18.3% [95% CI: 16.4-20.2%] vs. 11.7% [95%CI: 10.3-13.1%]) compared to participants without IR (all p<0.05).\n\n\nCONCLUSIONS\nFour-in-ten young American adults have IR, which occurs in a cluster with cardiometabolic risk factors. Nearly half of young adults with IR are non-obese. Screening efforts for IR irrespective of BMI may be required.