Why do children and low-income groups bear disproportionate, preventable metabolic harm?

The report notes that multimorbidity occurs earlier in deprived communities and documents very high contributions of ultra-processed foods to toddlers’ and preschoolers’ energy intake. It also links early disease onset, such as diabetes in youth, with dramatically higher lifetime burden.

When young people are diagnosed with prediabetes and T2DM, this sets the metabolic ‘stage’ for a spectrum of illnesses at an earlier stage than previous generations, which can then undermine health, wellbeing and productivity in the years to come. This can be described as years lost to disease which are often measured using Disability Adjusted Life Years (DALYs), which combine years of life lost due to premature death and years lived with disability. This is different from dying earlier from a condition. Dying earlier is often referred to as 'years of life lost to mortality' YLLs.

It's important to recognise the tragedy of early illness that is disabling for years, - as well as early death. This report outlines compelling evidence that a wide range of metabolic and brain-related chronic conditions can be substantially reduced/mitigated, but can also be reversed and arepreventable. For example, there is strong evidence that when faced with trauma including earthquakes and floods, people with better nutrient status recover more quickly and are over time, less traumatised.

Food insecurity is a persistent problem in New Zealand. Māori and Pasifika populations are most vulnerable to food insecurity in New Zealand, while women experience food insecurity more than men and foodbanks cannot provide people with adequate nutrition. Food insecure individuals often have limited access to nutrient-rich foods including fruits, vegetables, and meat protein, and much greater access to highly processed foods which are high in refined carbohydrates and processed fats.

Prediabetes in children and adolescents is increasingly common and biomarkers show that prediabetes carries the same metabolic risks as type 2 diabetes mellitis. The U.S. Centre for Disease Control (CDC) recently identified that 32% of U.S. adolescents between 12-17 years had prediabetes.

New Zealand lacks national data on prediabetes and may have higher rates of prediabetes in children and adolescents than has been formally recognised. A 2021 New Zealand study measured blood glucose (HbA1c) in 451 children, aged 8-11 years. Prediabetes was present in 71 (16%) children and was greatest in South Asian (n=13, 30%), Pacific Island (n=29, 27%) and Māori (n=10, 18%) children, compared with European children (n=10, 6.0%) (P< 0.001).

Diabetes is also discussed in Chapter 2. It is thought that the prevalence of diabetes has been increasing by 7% per year.[58] A 2025 paper calculated that:

Aotearoa New Zealand will experience a significant increase in the absolute volume of prevalent diabetes, rising by nearly 90% to more than 500,000 by 2044. The age-standardised prevalence of diabetes will increase from around 3.9% of the population (268,248) to 5.0% overall (502,358). The prevalence and volume of diabetes diagnoses will increase most drastically for Pacific peoples, most notably Pacific females for whom diabetes prevalence is projected to increase to 17% of the population by 2044.[59]

The current annual cost of T2DM in New Zealand is estimated to be $2.1 billion. PWC calculated that the annual cost would increase by 63% to $3.5 billion in the next 20 years.[60] PWC drew attention to the additive costs of a diagnosis in youth:

the personal and economic impact of the disease is most detrimental when a person is diagnosed early in life. When comparing the lifetime cost of someone diagnosed with type 2 diabetes at age 25 years ($565k) to the lifetime cost of someone diagnosed at age 75 years ($44k), the cost differential is $521k or a factor of 13. This is significant given the shift towards younger cohorts of New Zealanders developing type 2 diabetes.

Why do children and low-income groups bear disproportionate, preventable metabolic harm?

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