Prevalence of Optimal Metabolic Health in U.S. Adolescents, NHANES 2007-2016

While the overweight and obesity epidemic in the adolescent population is well described, a comprehensive evaluation of cardiometabolic health markers has not been reported. Our purpose was therefore to determine the prevalence of cardiometabolic risk factors among non-diabetic individuals 12 to19 years of age in the United States. We analyzed data from nationally representative samples of U.S. adolescents (NHANES, 2007-2016). Optimal cardiometabolic health was defined as an absence of risk factors, that is, at least normal values on each of the following 11 measures: body mass index (BMI) percentile, waist circumference percentile, blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, non-HDL cholesterol, triglycerides, fasting plasma glucose, alanine aminotransferase, and insulin resistance. Domain analyses were conducted with Rao-Scott chi-square tests of independence. Multivariable linear/logistic regressions examined sociodemographic associations with cardiometabolic health. Less than a quarter of the population (22.0%; 95% CI; 19.4%-24.8%) was found to have no cardiometabolic risk factors. Among individuals with a normal BMI, 35.7% (95% CI; 31.6%-40.1%) had no cardiometabolic risk factors. Family poverty-to-income ratio was identified as an independent predictor of cardiometabolic health (P = 0.01). A consistent trend was present between increasing BMI percentile and number of cardiometabolic risk markers. The overall prevalence of U.S. adolescents with no cardiometabolic risk factors is less than 25%. Even among those without increased BMI, less than half meet all metabolic health criteria. In addition, socioeconomic disparities are predictors of metabolic health.