Obesity was not a universal phenotype among children with type 2 diabetes, despite being an important risk factor, according to a systematic review and meta-analysis published in JAMA Network Open.

“While the complex weave of factors driving the pathogenesis of pediatric type 2 diabetes are not yet fully defined, the biopsychosocial determinants of health with health inequities and social and economic vulnerabilities in this population play an important role in disease risk and outcomes,” M. Constantine Samaan, MD, MSc, associate professor in the department of pediatrics at McMaster University and a staff physician in the division of pediatric endocrinology at McMaster Children’s Hospital in Hamilton, Ontario, Canada, and colleagues wrote. “Obesity is a major trigger for screening for type 2 diabetes in clinical practice, yet the prevalence of obesity in the pediatric type 2 diabetes population is unknown.”

In this systematic review and meta-analysis, researchers searched through MEDLINE, Embase, CINAHL, Cochrane Library and Web of Science from inception to June 2022 and identified observational studies with at least 10 participants with reports on the prevalence of obesity in individuals with pediatric type 2 diabetes. Overall, researchers included 57 studies in the systematic review and 53 studies in the meta-analysis.

The primary outcome included pooled prevalence rates of obesity among children with type 2 diabetes. Secondary outcomes included pooled prevalence rates of obesity among children with type 2 diabetes by sex and race as well as associations between obesity and glycemic control and dyslipidemia.

Among individuals with pediatric type 2 diabetes, researchers observed an overall obesity prevalence of 75.27% with a prevalence of 77.24% at diabetes diagnosis among 4,688 children. Boys had higher odds of obesity compared with girls (78.65% vs. 59.2%; OR = 2.1; 95% CI, 1.33-3.31; P = .03) and, compared with other racial groups, Asian children had the lowest obesity prevalence (64.5%) and white children had the highest (89.86%; P < .001 for both).

In addition, when assessing obesity prevalence by region, North America had the highest prevalence among children with type 2 diabetes compared with Europe (81.14% vs. 68.3%; P < .001 for both).

There were no significant associations between obesity prevalence and dyslipidemia or HbA1c levels in children with type 2 diabetes.

“Further research is needed to evaluate the causes of sex- and race and ethnicity-based associations of diabetes with obesity and explore additional factors that may affect the risk of developing type 2 diabetes apart from obesity in children,” the researchers wrote.