School Meal Participation, Overall Dietary Intake and Prediabetes Prevalence Among US Adolescents: Insights from the National Health and Nutrition Examination Survey (2017-2023)
Year: 2026
Type: other
Abstract: Objectives: Prediabetes is an emerging public health concern among U.S. adolescents, yet nationally representative, up-to-date data on dietary contributors remain limited. Especially, the role of overall dietary intake and school meal participation (providing a substantial portion of daily calories in school children) has not been comprehensively evaluated. This study examined cross-sectional associations between school meal participation, overall dietary intake, and prediabetes (defined as having HbA1c and/or fasting glucose values within the prediabetes range) in the most recent nationally representative samples of U.S. adolescents, assessing differences by obesity status. Research Design and Methods: The National Health and Nutrition Examination Survey data (2017–2020, 2021–2023) were analyzed, including adolescents (12–18y) with complete fasting glucose and HbA1c data (n=802). Multivariable modified Poisson regression models evaluated associations between school meal participation (breakfast/lunch), dietary intake (food groups/nutrients), and prediabetes. Effect modification by obesity status was assessed. Results: Prediabetes prevalence was 33.8% (standard error: 3.0) and obesity prevalence 20.96% (1.44). School breakfast participation at least once a week was associated with higher prediabetes prevalence (prevalence ratio [PR]: 1.3 (95% CI: 1.01–1.66), while school lunch participation was not. Higher vitamin E and B6 intake was linked to lower prediabetes prevalence (0.96, 0.94–0.99; 0.9, 0.81–0.99). Higher fruit intake was inversely (0.96, 0.92–0.99) associated with prediabetes among adolescents with obesity. Conclusion: School breakfast participation and specific dietary components were associated with prediabetes risk in US adolescents. While confirmation is needed, the nutritional quality of school breakfasts may represent an important intervention target. Key words: Adolescence, prediabetes, obesity, school meals, breakfast, lunch, overall dietary intake Article insights • Why did we undertake this study? Evidence linking school meals and overall diet to prediabetes in U.S. adolescents is limited, outdated, and rarely considers obesity status in nationally representative data. • What specific question did we ask? We cross-sectionally examined whether school breakfast/lunch participation and overall dietary intake were associated with prediabetes (defined based on HbA1c and/or fasting glucose values) in U.S. adolescents, and whether associations differed by obesity status. • What did we find? School breakfast participation was associated with higher prediabetes prevalence. Higher vitamin E and B6 intakes were associated with lower prediabetes prevalence. Higher fruit intake was inversely associated with prediabetes among adolescents with obesity. • What are the implications? Findings highlight school meal quality as a promising target for prevention while underscoring the need for longitudinal and intervention studies.
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7213347663