School Meal Participation, Overall Dietary Intake, and Prediabetes Prevalence Among U.S. Adolescents: Insights From the National Health and Nutrition Examination Survey (2017–2023)

Abstract

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. National Health and Nutrition Examination Survey data (2017–2020, 2021–2023) were analyzed, including adolescents (aged 12–18 years) with complete fasting glucose and HbA1c data (n = 802). Multivariable modified Poisson regression models evaluated associations between school meal participation (breakfast and lunch), dietary intake (food groups and nutrients), and prediabetes. Effect modification by obesity status was assessed. Prediabetes prevalence was 33.8% (SE 3.0) and obesity prevalence was 20.96% (SE 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 (PR 0.96, 0.94–0.99; 0.9, 0.81–0.99). Higher fruit intake was inversely (PR 0.96, 0.92–0.99) associated with prediabetes among adolescents with obesity. School breakfast participation and specific dietary components were associated with prediabetes risk in U.S. adolescents. While confirmation is needed, the nutritional quality of school breakfasts may represent an important intervention target.