Abstract
Background: The prevalence of both pediatric obesity and type 2 diabetes mellitus (T2DM) are on the rise globally. The goal of this systematic review and meta-analysis was to determine the proportion of children with obesity with and without T2DM in the USA, and to assess ethnic variations in these associations. Methods: We extracted data on obesity prevalence from the National Health and Nutrition Examination Survey, reporting on children without T2DM aged 2-19 between 1999-2018. Ethnicity data were extracted from the 2017-2018 survey. We also performed literature searches in several databases to identify eligible studies. Two reviewers independently screened for primary research articles with observational study designs, evaluating obesity prevalence in children with T2DM. A meta-analysis was performed using the random-effects model. Results: The overall prevalence of obesity was 16.6% in children without T2DM (n = 36,167), and 86.3% (95% CI 81.1%-90.8%) in children with T2DM (n = 2,575) across 11 eligible studies. When stratifying by ethnicity in non-T2DM and T2DM youth, the prevalence rates were 25.6% and 81.3% (95% CI 65.3%-93.5%) in Hispanic, 24.2% and 83.5% in non-Hispanic Black, 16.1% and 79.0% in non-Hispanic White, and 8.7% and 71.0% in non-Hispanic Asian youth, respectively. Conclusions: While the prevalence of obesity in children with T2DM was significantly higher than in those without T2DM, not all youth with T2DM had obesity. Non-Hispanic Asian children had the lowest obesity rates with T2DM when compared to other groups. Further research is needed to determine the factors driving T2DM with or without obesity in different ethnic groups.