Increased prevalence of diabetes and obesity among young US adults

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Literature - Aggarwal R, Weh RW, Joynt Maddox KE, et al. - JAMA. 2023 Mar 21;329(11):899-909. doi: 10.1001/jama.2023.2307.

Introduction and methods


The onset of CV risk factors early in life is associated with higher risk of CVD and CV events later in life, and a substantial loss of disability-adjusted life-years and years of life [1-2]. It is therefore important to determine the prevalence of CV risk factors among young adults, as a rise in the burden of CV risk factors could have major public health implications in an aging population.

Aim of the study

The authors investigated if the prevalence of CV risk factors, treatment rates, and control rates changed among young American adults from 2009 to 2020. They investigated this in the overall study population, and stratified by sex, and race and ethnicity.


This was a serial cross-sectional study, using data from the American National Health and Nutrition Examination Survey (NHANES) from 2009 till March 2020. 12,924 adults aged 20 to 44 years old were included. Each NHANES survey was conducted in a 2-year cycle. Because of the COVID-19 pandemic, data from the 2017-2018 and 2019-2020 cycles were combined to ensure nationally representative estimates . Data were collected through in-person interviews and medical examinations. Age, sex, race, and treatment rates were self-reported.


The main outcome was the prevalence of CV risk factors (hypertension, diabetes, hyperlipidemia, obesity, and smoking history).

Main results


  • The prevalence of hypertension in young adults was 9.3% (95%CI: 8.1-10.5) in 2009-2010 and 11.5% (95%CI: 9.6-13.4) in 2017-2020 (P=0.09 for linear trend).
  • The prevalence of diabetes and obesity in young adults significantly increased from 2009-2010 to 2017-2020 (3.0% [95%CI: 2.2-3.7] vs. 4.1% [95%CI: 3.5-4.7] for diabetes, P=0.01 for trend; 32.7% [95%CI: 30.1-35.3] vs. 40.9% [95%CI: 38.6-42.3] for obesity, P<0.001 for trend; respectively).
  • The prevalence of hyperlipidemia in young adults significantly decreased over the study period (from 40.5% [95%CI: 38.6-42.3] in 2009-2010 to 36.1% [95%CI: 33.5-38.7] from 2017-2020; P=0.002 for trend).
  • Smoking history did not change in young adults over the study period (P=0.99 for linear trend).
  • Similar changes in the prevalence of CV risk factors were reported for women and men.

Prevalence stratified by race and ethnicity

  • The prevalence of hypertension was the highest among young black adults, and stayed similar over the study period (16.2% [95%CI: 14.0-18.4] in 2009-2010 and 20.1% [95%CI: 16.8-23.3] in 2017-2020; P=0.24 for trend). In contrast, the prevalence of hypertension among young Mexican American adults and young Hispanic adults increased over the study period (6.5% [95%CI: 5.0-8.0] vs. 9.5% [95%CI: 7.3-11.7] for Mexican Americans; P=0.05 for trend; 4.4% [95%CI: 2.1-6.8] in 2009-2010 vs. 10.5% [95%CI: 6.8-14.3] in 2017-2020 for Hispanics; P=0.01 for trend).
  • The prevalence of diabetes significantly increased among young Mexican American adults (from 4.3% [95%CI: 2.3-6.2] to 7.5% [95%CI: 5.4-9.6]; P=0.007 for trend).
  • The prevalence of diabetes increased among young Asian, Mexican American, other Hispanic and white adults, but not among young Black adults.

Treatment and control rates

  • Treatment rates did not change among young adults with hypertension over the study period (56.5% [95%CI: 47.7-65.3] in 2009-2010 to 53.7% [95%CI: 47.6-59.8%] in 2017-2020; P=0.80 for trend). Moreover, blood pressure control rates did not change over the study period among young adults who received treatment (65.0% [95%CI: 55.8-74.2] in 2009-2010 vs. 74.8% [95%CI: 67.5-82.1] in 2017-2020; P=0.91 for trend).
  • Among young adults with diabetes, the treatment rates did not significantly change over the study period (62.4% [95%CI: 51.2-73.6] in 2009-2010 and 54.5% [95%CI: 42.3-66.7] in 2017-2020; P=0.38 for trend). Among those receiving treatment, the glycemic control rates did not significantly improve over the study period (45.5% [95%CI: 27.7-63.3] in 2009-2010 vs. 56.6% [95%CI: 39.2-73.9] in 2017-2020; P=0.22 for trend).


The prevalence of diabetes and obesity increased (+1.1% and +8.2%, respectively) in American adults aged 20 to 44 years from 2009 to 2020, whereas the prevalence of hypertension did not change and the prevalence of hyperlipidemia decreased (-4.4%). There were significant differences between the prevalence of CV risk factors among people from different racial and ethnic backgrounds. A rising burden of CV risk factors was detected in Hispanic, and Mexican American adults. Moreover, treatment and control rates did not significantly improve over the study period.


1. Armstrong AC, Jacobs DR Jr, Gidding SS, et al. Framingham score and LV mass predict events in young adults: CARDIA study. Int J Cardiol. 2014;172(2):350-355.

2. Jacobs DR Jr, Woo JG, Sinaiko AR, et al. Childhood cardiovascular risk factors and adult cardiovascular events. N Engl J Med. 2022;386(20):1877-1888.

Find this article online at JAMA.

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