Age-related divergence in diabetes risk profiles between adults aged 20 to 24 and 35 to 39 years in rural eastern Uganda

Background In sub-Saharan Africa, the rising burden of non-communicable diseases is increasingly affecting younger adults, yet the age at which diabetes-related risk factors begin to accumulate in rural populations remains poorly defined. This study compared diabetes-related risk profiles between adults aged 20–24 and 35–39 years in rural eastern Uganda to identify where in early adulthood the steepest rises occur. Methods Comparative cross-sectional study of 520 adults randomly sampled from the Iganga-Mayuge Health and Demographic Surveillance Site (331 aged 20–24; 189 aged 35–39). Participants completed a socio-behavioural questionnaire, anthropometric and clinical assessment, and biochemical assays. Adjusted prevalence ratios (APR) were estimated using modified Poisson regression. Results Those aged 35–39 had higher prevalence of alcohol use (6.9% vs 2.4%; APR 1.8), frequent drinking (APR 2.2) and binge drinking (APR 2.0), and less recreational physical activity (APR 0.2). Elevated BMI (43.9% vs 23.0%), obesity (15.9% vs 3.9%), abdominal obesity (10.1% vs 1.5%) and elevated apolipoprotein B (11.3% vs 2.7%) were more common in the older group (all p < 0.001). FPG-defined diabetes occurred in 3.1% of those aged 35–39 versus none aged 20–24. Hypertension prevalence was 10.3% in the younger group. NCD screening (29.4%) and health education (7.7%) coverage were low. Conclusions The late twenties to early thirties are a critical window for NCD prevention in rural eastern Uganda. Earlier screening, targeted alcohol and physical activity interventions, and integration of NCD prevention into routine primary care are needed. Clinical trial number: Not applicable.