Effect of BMI on Lifetime Risk for Diabetes
in the U.S.
K.M.V. NARAYAN, MD
JAMES P. BOYLE, PHD
THEODORE J. THOMPSON, MS
EDWARD W. GREGG, PHD
DAVID F. WILLIAMSON, PHD
OBJECTIVE — At birth, the lifetime risk of developing diabetes is one in three, but lifetime
U.S. for age-, sex-, and ethnicity-specific subgroups.
RESEARCH DESIGN AND METHODS — National Health Interview Survey data (n ?
780,694, 1997–2004) were used to estimate age-, race-, sex-, and BMI-specific prevalence and
incidence of diabetes in 2004. U.S. Census Bureau age-, race-, and sex-specific population and
mortality rate estimates for 2004 were combined with two previous studies of mortality to
estimate diabetes- and BMI-specific mortality rates. These estimates were used in a Markov
model to project lifetime risk of diagnosed diabetes by baseline age, race, sex, and BMI.
RESULTS — Lifetime diabetes risk at 18 years of age increased from 7.6 to 70.3% between
risk differences (percent) increased from 3.7 to 23.9 percentage points between overweight and
very obese men and from 8.7 to 26.7 percentage points for women. The impact of BMI on
diabetes duration also decreased with age.
CONCLUSIONS — Overweight and especially obesity, particularly at younger ages, sub-
stantially increases lifetime risk of diagnosed diabetes, while their impact on diabetes risk, life
expectancy, and diabetes duration diminishes with age.
Diabetes Care 30:1562–1566, 2007
diabetes in the U.S. in 2000 was 33% for
groups (3). BMI is a powerful and modi-
fiable risk factor for diabetes (4,5). How-
ever, the impact of BMI on the lifetime
risk of diabetes has not been evaluated,
and no data are available on the compar-
ative lifetime risks of diabetes across cat-
egories of BMI. Because lifetime risk
estimates are easily understood measures
of the impact of disease in individuals
he prevalence of diagnosed diabetes
among U.S. adults has risen twofold
in the past 40 years and 75% during
(6,7), they have been used in public edu-
cation campaigns for disease prevention
(10–14). Lifetime risk estimates for di-
abetes according to BMI would be valu-
able for 1) communicating an indi-
vidual’s risk of diabetes given his/her
BMI and 2) identifying groups of indi-
viduals who would benefit most from
In this study, we estimate the lifetime
risk of diabetes (risk from age 18 years
until death or age 85 years) by baseline
age, race, sex, and BMI for the U.S. pop-
ulation and present the results in a form
suitable for communication with individ-
uals at risk and with policy makers.
RESEARCH DESIGN AND
METHODS — We calculated preva-
lence and incidence rates for 2004 from
the nationally representative U.S. Na-
tional Health Interview Survey (NHIS)
data (8–11). Multiyear data (1997–
2004) were modeled to improve preci-
sion of estimates for 2004. The NHIS is
an ongoing, continuous, nationwide,
cross-sectional survey of the U.S. nonin-
stitutionalized population. The NHIS
uses a multistage probability sampling
strategy to select households and individ-
uals each year. Between 1997 and 2004,
301,840 households and 780,694 indi-
viduals participated, and in 2004 alone,
36,579 households and 94,460 individu-
als participated. The overall response rate
varies annually but is ?90%.
Prevalence was assessed from the an-
told by a doctor or health professional
(other than during pregnancy, if female)
that you have diabetes or sugar diabetes?”
Incidence was assessed from age at the
tion, “How old were you when a doctor
first told you that you had diabetes or
sugar diabetes?” We calculated the num-
ber of years each person had been diag-
nosed with diabetes by subtracting the
age at which they were diagnosed from
their current age. Adults who had a value
of 0 were identified as having been diag-
nosed with diabetes within the last year;
were classified as having been diagnosed
with diabetes within the last year. Self-
reported weight and height were used to
There were 15,843 prevalent cases of
diagnosed diabetes among the 242,957
respondents, and 1,514 incident cases
among the 228,628 nondiabetic respon-
dents, aged 18–84 years, in the NHIS for
1997–2004. We used Bayesian hierarchi-
cal logistic regression (12) with random
intercepts by calendar year to estimate di-
tion of age (18–84 years in 1-year
intervals), race/ethnicity (non-Hispanic
white, non-Hispanic black, Hispanic, or
other), sex, and BMI (underweight,
?18.5 kg/m2; normal weight, 18.5 to
?25 kg/m2; overweight, 25 to ?30 kg/
m2; obese, 30 to ?35 kg/m2; and very
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
From the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
& Epidemiology, Emory University, Atlanta, GA 30322. E-mail: firstname.lastname@example.org.
Received for publication 19 December 2006 and accepted in revised form 8 March 2007.
Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/
Abbreviations: NHIS, National Health Interview Survey.
A table elsewhere in this issue shows conventional and Syste `me International (SI) units and conversion
factors for many substances.
© 2007 by the American Diabetes Association.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby
marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
C a r d i o v a s c u l a r a n d M e t a b o l i c R i s k
O R I G I N A LA R T I C L E
DIABETES CARE, VOLUME 30, NUMBER 6, JUNE 2007