Insulin Resistance and Cardiometabolic Risk Profile Among Nondiabetic American Young Adults: Insights From NHANES

Vibhu Parcha; Brittain Heindl; Rajat Kalra; Peng Li; Barbara Gower; Garima Arora; Pankaj Arora


J Clin Endocrinol Metab. 2022;107(1):e25-e37. 

In This Article

Abstract and Introduction


Background: The burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated (1) the prevalence and trends of IR and cardiometabolic risk factors and (2) the association between measures of adiposity and IR among adults 18 to 44 years of age without diabetes and preexisting cardiovascular disease.

Methods: Cross-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.

Results: Among 6247 young adults 18 to 44 years of age, 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 (P for trend = 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 Ps < 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 Ps < 0.05).

Conclusions: Four-in-10 young American adults have IR, which occurs in a cluster with cardiometabolic risk factors. Nearly half of young adults with IR are nonobese. Screening efforts for IR irrespective of BMI may be required.


Insulin resistance (IR) is associated with metabolic disturbances that contribute to the development of atherosclerotic cardiovascular diseases (ASCVD). IR is associated with obesity, hypertension, reduced high-density lipoprotein cholesterol (HDL-C) levels, and elevated triglyceride levels, which are also components of metabolic syndrome.[1–3]

It is well-established that individuals with IR have an increased risk of adverse cardiovascular events and all-cause mortality.[2–7] The presence of IR in early adulthood is associated with an early and significant predisposition to ASCVD events later in life.[2,3,8–11] However, the contemporary trends of IR in young adults have not been evaluated in a nationwide population. Additionally, the important racial and sex-related differences in IR remain unclear in this age group.[12–18] Adiposity has been associated with worsening IR and diabetes.[19–22] However, the relationship of IR with various measures of generalized and localized adiposity among young American adults is also not known. Given the clinical implications of IR in the development of ASCVD, characterization of the prevalence of IR among young American adults is crucial. Since IR may not occur in isolation, it is important to assess the prevalence and trends of cardiometabolic risk factors alongside IR among young American adults. Furthermore, the distribution of social determinants of health, which are known to influence the incidence and prevalence of ASCVD, in a nationally representative population of young American adults with IR is not known.[23–37]

We examined young adult participants without diabetes, 18 to 44 years of age, in the National Health and Nutrition Examination Survey (NHANES) 2007–2018 to evaluate (1) the association of measures of adiposity with IR, (2) the prevalence and temporal trends in IR (overall and stratified by sex and race), and (3) the prevalence and trends of cardiometabolic risk factors stratified by IR status.