How to Prevent Prediabetes in Children

Prediabetes is not just a high risk state for the development of diabetes–prediabetes can be a disease itself. People with prediabetes may already have damage to their eyes, kidneys, blood vessels, and heart.

Evidence from numerous studies suggests that the chronic complications of type 2 diabetes start to develop during the prediabetic state. So by the time we have prediabetes, it may already too late to prevent organ damage, so best to prevent prediabetes in the first place, and the earlier the better.

Thirty years ago, virtually all diabetes in young individuals was thought to be autoimmune type 1 diabetes. But since the mid-90s we started to see an increase in type 2 diabetes among our youth, particularly in the United States. Indeed, the term adult-onset diabetes has now been scrapped and replaced with “Type 2” because children as young as eight are now developing the disease. And the effects can be devastating. A fifteen-year follow-up of children diagnosed with Type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure, and death in young adulthood.

Why the dramatic rise in childhood diabetes? Because of the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased by more than 100%. Once an obese child reaches age 6, it’s likely they’ll stay that way. And even if they don’t, being overweight in our youth predicts adult disease and death regardless of adult body weight, even if we lose it.

Being an overweight teen may predict disease risk 55 years later. Twice the risk of dying from heart attack, more cancer, gout, arthritis. In fact being overweight as a teen was a more powerful predictor of these risks then being overweight in adulthood. This underscores the importance of focusing on preventing childhood obesity.

How do we do it? From the official American Academy of Pediatrics clinical practice guidelines. The problem appears to be kids eating too much fat, and added sugars, and not eating enough fruits and vegetables.

Doctors, at every occasion beginning soon after a child’s birth, should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like?

The chair of the nutrition department at Loma Linda University published a paper suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians. This is from the largest such study to date.

A body mass index over 30 is considered obese, 25 to 30 overweight, and under 25 ideal weight. The non-vegetarians were up at 28.8, the average meateater in the U.S. is significantly overweight. As one gets more and more plant based the average BMI drops. But even the average vegetarian in the U.S. is overweight. The only dietary group that was, on average, ideal weight, were those eating strictly plant-based. So that’s about a 33-pound difference between the vegans and the meateaters.

Vegetarian children grow up not only thinner, but taller. Vegetarian kids grow to be about an inch taller than other kids. Apparently meat intake is somehow negatively associated with height.

I can just hear the dairy council saying it’s because all the milk the veggie kids must be drinking, but no. The veg kids consumed significantly less dairy, and much lower animal protein intake overall.

Meat intake is apparently associated with growing wider, though. In school-aged children, the consumption of animal foods (meats, dairy, or eggs) is associated with an increased risk of overweight, whereas plant-based equivalents like veggie burgers, veggie dogs, veggie cold cuts were not, and the whole plant foods like grains, beans, and nuts were found to be protective.

This may be because plant-based diets are low in energy density and high in starch, fiber, and water, which may increase feelings of fullness and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, such that you just burn more calories at rest, even when you’re sleeping. However, we’re not sure how much of the benefits are due to increased consumption of plant foods versus decreased consumption of meat.

Either way, plant-based diets should be encouraged and promoted for optimal health. Local, national, and international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic, and political forces that make it difficult to promote such diets.

For example, although the advice to consume a plant-based diet is sound, questions arise concerning the relatively high price of produce. Yes we could reduce the burden of childhood obesity, prevent the further spread of the disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels.

Fruits and vegetables may not fit on the Dollar Menu, but our kids are worth it. Getting diabetes in childhood cuts nearly 20 years of their life. Who among us wouldn’t go to the ends of the Earth to enable our kids to live 20 years longer?

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

• SC Springer, J Silverstein, K Copeland, J Silverstein, K R Moore, G E Prazar, T Raymer, R N Shiffman, S C Springer, V V Thaker, M Anderson, S J Spann, S K Flinn. Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and adolescents. Pediatrics 2013 131(2):364 – 382.
• T S Hannon, G Rao, S A Arslanian. Childhood obesity and type 2 diabetes mellitus. Pediatrics 2005 116(2):473 – 480.
• R E Pratley. The early treatment of type 2 diabetes. Am. J. Med. 2013 126(9 - Suppl - 1):S2 – 9.
• N D Spector, S F Kelly. Pediatrician's role in screening and treatment: Bullying, prediabetes, oral health. Current opinion in pediatrics 2006 18(6):661 – 670.
• A M G Cali, S Caprio. Prediabetes and type 2 diabetes in youth: An emerging epidemic disease? Current opinion in endocrinology, diabetes and obesity 2008 15(2):123 – 127.
• J Sabaté, M Wien. Vegetarian diets and childhood obesity prevention. Am. J. Clin. Nutr. 2010 91(5):1525S - 1529S.
• S Finfer, R Bellomi, D Blair, S Su, D Foster, V Dhingra, D Cook, P Dodek, W R Henderson, P C Hebert, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26;360(13):1283-97.
• T Reinehr. Type 2 diabetes mellitus in children and adolescents. World J Diabetes 2013 4(6):270 – 281.
• P K Newby. Plant foods and plant-based diets: Protective against childhood obesity? Am. J. Clin. Nutr. 2009 89(5):1572S - 1587S.
• K Khavandi, H Amer, J Brownrigg, B Ibrahim. Strategies for preventing type 2 diabetes: An update for clinicians. Therapeutic advances in chronic disease 2013.
• K D Brownell, K E Warner. The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food? Milbank Q. 2009 Mar;87(1):259-94.
• A G Tabak, C Herder, W Rathmann, E J Brunner, M Kivimaki. Prediabetes: a high-risk state for diabetes development. Lancet. 2012 Jun 16;379(9833):2279-90.
• A Must, P F Jaques, G E Dallai, C J Bajema, W H Dietz. Long-term morbidity and mortality of overweight adolescents. N Engl J Med. 1992 Nov 5;327(19):1350-5.
• J Sabaté, K D Lindsted, R D Harris, A Sanchez. Attained height of lacto-ovo vegetarian children and adolescents. Eur J Clin Nutr. 1991 Jan;45(1):51-8.

Images thanks to Joe 13 via Flickr.

• animal fat
• animal products
• animal protein
• arthritis
• autoimmune diseases
• beans
• calories
• cancer
• cardiovascular disease
• children
• cost savings
• dairy
• diabetes
• eggs
• eye health
• fat
• fiber
• fruit
• gout
• grains
• heart disease
• industry influence
• kidney disease
• kidney failure
• meat
• milk
• mortality
• nuts
• obesity
• Plant-Based Diets
• prediabetes
• sugar
• vegans
• vegetables
• vegetarians
• veggie burgers
• vision
• water
• weight loss