Cardiometabolic Risk Factors leading to Diabetes Mellitus among the Young (YOD) from the 8th Philippine National Nutrition Survey




young-onset diabetes mellitus, Filipinos, metabolic syndrome, cardiovascular disease


*Visual Abstracts prepared by Dr. Carmen Carina Cabrera

Objectives. This study looked into the prevalence of diabetes mellitus (DM) and risks for cardiovascular and metabolic diseases among young adults with diabetes (age 20-44 years old, YOD) and late-onset DM (≥45 years old, LOD) in Filipinos.

Methodology. Weighted data from 546,580 adults with DM from the 8th Philippine National Nutrition and Health Survey (NNHeS) were utilized. Differences in sociodemographic, anthropometric, clinical profiles and metabolic risks were compared between YOD and LOD.

Results. The aggregated prevalence of DM is 5.43% (95%CI, 5.10–5.79), YOD were 2.64% (95% CI, 2.32–3.00) and LOD 9.85% (95%CI, 9.18–10.56). Mean age of YOD was 37,6 years, LOD 59,9 years. The YOD were mostly males (56%), with higher BMI (26.24 kg/m2 vs 25 kg/m2, p=0.002), lower mean SBP (122.41±19.17 mmHg vs 135.45±22.47 mmHg, p<0.001), more daily smokers (23% vs 14%), and alcoholic beverage drinkers (39% vs 31%). Physical activity was similar between groups (44% vs 51%, p=0.078). However, average total caloric intake (1776.78±758.38 kcal vs 1596.88±639.16 kcal, p=0.023) and carbohydrate intake (306.13±142.16 grams vs 270.53±104.74 g, p=0.014) were higher in YOD. Dietary carbohydrate proportions were higher than recommended (69% vs 68%) for both groups.
Young Filipinos had higher risk to develop diabetes when they are obese II (22% vs 12%), current drinker (56% vs 37%), and current smoker (28% vs 18%). Eighty percent of YOD and LOD had metabolic syndrome (MetS). With every unit increase in age and fat intake, the odds of having MetS were raised by 5.4% (95%CI 1%–10%, p=0.029) and 1.6% (95%CI 0.04%-3%, p=0.044), respectively.

Conclusion. Early-onset diabetes mellitus appears to be driven by obesity, MetS and social behaviors. Modifiable risk factors can be improved early to decrease hazards to develop cardiometabolic complications.


Download data is not yet available.


Cho NH. IDF Diabetes Atlas, 9th ed. Brussels, Belgium; 2019. International Diabetes Federation. 2020. Available from

Dayrit MM, Lagrada MLP, Picazo OF, Pons MC, Villaverde MC. The Philippines Health System Review. Asia Pacific Observatory on Health Systems and Policies; 2018. Available from

Yeung RO, Zhang Y, Luk A, et al. Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): A cross-sectional study of a prospective cohort. Lancet Diabetes Endocrinol . 2014;2(12):935–43.

Saydah SH, Siegel KR, Imperatore G, Mercado C, Gregg EW. The cardiometabolic risk profile of young adults with diabetes in the U.S. Diabetes Care. 2019;42(10):1895–902.

FNRI. Philippine Nutrition Facts and Figures 2013: 8th National Nutrition Survey Overview [Internet]. 2015. Available from

Hu C, Jia W. Diabetes in China: Epidemiology and genetic risk factors and their clinical utility in personalized medication. Diabetes. 2018;67(1):3–11.

Wu Y, Wang L, Cai Z, Bao L, Ai P, Ai Z. Prevalence and risk factors of low health literacy: A community-based study in Shanghai, China. Int J Environ Res Public Health. 2017;14(6).

Ong YH, Koh WCA, Ng ML, et al. Glutamic acid decarboxylase and islet antigen 2 antibody profiles in people with adult-onset diabetes mellitus: A comparison between mixed ethnic populations in Singapore and Germany. Diabet Med. 2017;34(8):1145–53.

Chan JCN, Lau ESH, Luk AOY, et al. Premature mortality and comorbidities in young-onset diabetes: A 7-year prospective analysis. Am J Med. 2014;127(7):616–24.

Sahoo S, Zaidi G, Vipin V, et al. Heterogeneity in the aetiology of diabetes mellitus in young adults: A prospective study from north India. Indian J Med Res. 2019;149(4):479–88.

Dubose SN, Hermann JM, Tamborlane WV, et al. Obesity in youth with type 1 diabetes in Germany, Austria, and the United States. J Pediatr. 2015;167(3):627–32.e1-4.

Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2 diabetes: A position statement by the American Diabetes Association. Diabetes Care. 2018;41(12):2648-68.

Nip ASY, Reboussin BA, Dabelea D, et al. Disordered eating behaviors in youth and young adults with type 1 or type 2 diabetes receiving insulin therapy: The SEARCH for diabetes in youth study. Diabetes Care. 2019;42(5):859-866.

Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122.

World Health Organization. Waist circumference and waist–hip ratio: Report of a WHO Expert Consultation; 2008. Available from

Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist: Hip ratio as predictors of cardiovascular risk--Aa review of the literature. Eur J Clin Nutr. 2010;64(1):16–22.

Pagsisihan DA, Sandoval MA, Paz-Pacheco E, Jimeno C. Low indices of overweight and obesity are associated with cardiometabolic diseases among adult Filipinos in a rural community. J ASEAN Fed Endocr Soc. 2016;31(2):97-105.

Araneta MRG, Wingard DL, Barrett-Connor E. Type 2 diabetes and metabolic syndrome in Filipina-American women: A high-risk nonobese population. Diabetes Care. 2002;25(3):494–9.

Luk AOY, Lau ESH, So WY, et al. Prospective study on the incidences of cardiovascular-renal complications in Chinese patients with young-onset type 1 and type 2 diabetes. Diabetes Care. 2014;37(1):149–57.

Chang SA. Smoking and type 2 diabetes mellitus. Diabetes Metab J. 2012;36(6):399–403.

Sargeant L a, Khaw KT, Bingham S, Day NE, Luben RN, Oakes S, et al. Cigarette smoking and glycaemia: The EPIC-Norfolk Study. European Prospective Investigation into Cancer. Int J Epidemiol. 2001;30(3):547–54.

Rimm EB, Chan J, Stampfer MJ, Colditz GA, Willett WC. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ. 1995;310(6979):555–9.

Campagna D, Alamo A, Di Pino A, Russo C, Calogero AE, Purrello F, et al. Smoking and diabetes: Dangerous liaisons and confusing relationships. Diabetol Metab Syndr. 2019;11(85).

Cai X, Chen Y, Yang W, Gao X, Han X, Ji L. The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: A meta-analysis. Endocrine. 2018;62(2):299–306.

Rawshani A, Rawshani A, Franzén S, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2018;379(7):633–44.

Cordain L, Melby CL, Hamamoto AE, et al. Influence of moderate chronic wine consumption on insulin sensitivity and other correlates of syndrome X in moderately obese women. Metabolism. 2000;49(11):1473–8. 11092514.

Ögge LE, Gerhard Brohall MD, Carl Johan Behre MD, Schmidt C, Fagerberg B. Alcohol consumption in relation to metabolic regulation, inflammation, and adiponectin in 64-year-old Caucasian women: A population-based study with a focus on impaired glucose regulation. Diabetes Care. 2006;29(4):908–13.

Baliunas DO, Taylor BJ, Irving H, et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care. 2009;32(11):2123–32. PMC2768203.

Holst C, Becker U, Jørgensen ME, Grønbæk M, Tolstrup JS. Alcohol drinking patterns and risk of diabetes: Aa cohort study of 70,551 men and women from the general Danish population. Diabetologia. 2017;60(10):1941–50.

Hu T, Jacobs DR, Larson NI, Cutler GJ, Laska MN, Neumark-Sztainer D. Higher diet quality in adolescence and dietary improvements are related to less weight gain during the transition from adolescence to adulthood. J Pediatr. 2016;178:188-193.e3.

Cha ES, Paul S, Braxter BJ, Umpierrez G, Faulkner MS. Dietary Behaviors and glucose metabolism in young adults at risk for type 2 diabetes. Diabetes Educ. 2018;44(2):158–67.

Wilmot E, Idris I. Early onset type 2 diabetes: Risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014;5(6):234–44. 10.1177/2040622314548679.

Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol. 2018;6(1):69–80.

Stanley K. Nutrition considerations for the growing population of older adults with diabetes. Diabetes Spectr. 2014;27(1):29–36.

World Health Organization. Urinary iodine concentrations for determining iodine status in populations [Internet]. World Health Organization; 2013. Available from

Al-Attas OS, Al-Daghri NM, Alkharfy KM, et al. Urinary iodine is associated with insulin resistance in subjects with diabetes mellitus type 2. Exp Clin Endocrinol Diabetes. 2012;120(10):618–22.

Sun Z, Wang X, Chen J, et al. [Effects of iodine excess on islet β cells(β-TC-6) function and the mechanism]. Wei Sheng Yan Jiu. 2017;46(4):610–4.

Angeles-Agdeppa I, Sun Y, Denney L, et al. Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey. Nutr J. 2019;18(59).

Zhou Y, Zhou J, Sun B, et al. Vitamin A deficiency causes islet dysfunction by inducing islet stellate cell activation via cellular retinol binding protein 1. Int J Biol Sci. 2020;16(6):947–57.

Pena G, Kuang B, Cowled P, et al. Micronutrient status in diabetic patients with foot ulcers. Adv Wound Care (New Rochelle). 2020;9(1):9–15.

Narasimhan S, Weinstock RS. Youth-onset type 2 diabetes mellitus: Lessons learned from the TODAY study. Mayo Clin Proc. 2014;89(6):806–16.

TODAY Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: The TODAY clinical trial. Diabetes Care. 2013;36(6):1735–41.

Chen G, McAlister FA, Walker RL, Hemmelgarn BR, Campbell NRC. Cardiovascular outcomes in Framingham participants with diabetes: The importance of blood pressure. Hypertension. 2011;57(5):891–7.

Maahs DM, Wadwa RP, Bishop F, Daniels SR, Rewers M, Klingensmith GJ. Dyslipidemia in Youth with Diabetes: To Treat or Not to Treat? J Pediatr. 2008;153(4):458–65. NIHMSID: NIHMS71611. 1]0.1016/j.jpeds.2008.05.062.

Rutherford JN, McDade TW, Feranil AB, Adair LS, Kuzawa CW. High prevalence of low HDL-c in the Philippines compared to the US: Population differences in associations with diet and BMI. Asia Pac J Clin Nutr. 2010;19(1):57–67. NIHMSID: NIHMS308702.

Jiang B, Zheng Y, Chen Y, et al. Age and gender-specific distribution of metabolic syndrome components in East China: Role of hypertriglyceridemia in the SPECT-China study. Lipids Health Dis. 2018;17(1):92.

Feinkohl I, Janke J, Hadzidiakos D, et al. Associations of the metabolic syndrome and its components with cognitive impairment in older adults. BMC Geriatr. 2019;19(1):77.

Devers MC, Campbell S, Simmons D. Influence of age on the prevalence and components of the metabolic syndrome and the association with cardiovascular disease. BMJ Open Diabetes Res Care. 2016;4(1):e000195. PMID: 27158519.

Paz-Pacheco E, Jimeno C. Diabetes Care in the Philippines. J ASEAN Fed Endocr Soc. 2015;30(2):118–24.

Goodman E, Dolan LM, Morrison JA, Daniels SR. Factor analysis of clustered cardiovascular risks in adolescence: Obesity is the predominant correlate of risk among youth. Circulation. 2005;111(15):1970–7.



How to Cite

Uy, A. B., & Jimeno, C. (2021). Cardiometabolic Risk Factors leading to Diabetes Mellitus among the Young (YOD) from the 8th Philippine National Nutrition Survey. Journal of the ASEAN Federation of Endocrine Societies, 36(1), 12–24.



Original Articles

Most read articles by the same author(s)

1 2 3 4 > >>