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Original Research

Asian Americans: Diabetes Prevalence Across U.S. and World Health Organization Weight Classifications

  1. Reena Oza-Frank, PHD, RD1,
  2. Mohammed K. Ali, MBCHB, MSC2,
  3. Viola Vaccarino, MD, PHD1,3 and
  4. K.M. Venkat Narayan, MD1,2,3
  1. 1Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Emory University, Atlanta, Georgia;
  2. 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;
  3. 3School of Medicine, Emory University, Atlanta, Georgia.
  1. Corresponding author: Reena Oza-Frank, roza{at}emory.edu.
Diabetes Care 2009 Sep; 32(9): 1644-1646. https://doi.org/10.2337/dc09-0573
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Abstract

OBJECTIVE To compare diabetes prevalence among Asian Americans by World Health Organization and U.S. BMI classifications.

RESEARCH DESIGN AND METHODS Data on Asian American adults (n = 7,414) from the National Health Interview Survey for 1997–2005 were analyzed. Diabetes prevalence was estimated across weight and ethnic group strata.

RESULTS Regardless of BMI classification, Asian Indians and Filipinos had the highest prevalence of overweight (34–47 and 35–47%, respectively, compared with 20–38% in Chinese; P < 0.05). Asian Indians also had the highest ethnic-specific diabetes prevalence (ranging from 6–7% among the normal weight to 19–33% among the obese) compared with non-Hispanic whites: odds ratio (95% CI) for Asian Indians 2.0 (1.5–2.6), adjusted for age and sex, and 3.1 (2.4–4.0) with additional adjustment for BMI.

CONCLUSIONS Asian Indian ethnicity, but not other Asian ethnicities, was strongly associated with diabetes. Weight classification as a marker of diabetes risk may need to accommodate differences across Asian subgroups.

In 2005–2006, the U.S. Asian population grew by 3.2%, to 14.9 million, the highest percentage growth of any race/ethnic group during that time period (1). Compared with other race/ethnic groups, Asians have higher adiposity per unit of BMI (2), leading to increased risk of type 2 diabetes at lower BMIs (3). This led to the 2002 consensus statement from the World Health Organization (WHO) on BMI in Asian populations, which uses lower cut points for BMI standards among Asians (normal weight 18.5–22.9 kg/m2, overweight 23.0–27.4 kg/m2, and obese ≥27.5 kg/m2) compared with the traditional standards (normal weight 18.5–24.9 kg/m2, overweight 25.0–29.9 kg/m2, and obese ≥30.0 kg/m2) (3). Despite continued attention to this issue, the utility of the WHO Asian BMI standard as a marker of diabetes risk remains unresolved.

RESEARCH DESIGN AND METHODS

Data on 7,414 Asian American and 140,291 non-Hispanic white adults aged 18–74 years were pooled from the nationally representative National Health Interview Survey (NHIS) for the years 1997–2005. One randomly selected adult per household was asked detailed information on use of health care services, health-related behavior, and health status (including height, weight, and diabetes).

Data were pooled to improve reliability of statistical estimates (4) by merging the adult person-level files for each year surveyed. National Center for Health Statistics (NCHS) guidelines were applied to combine NHIS data with the same sample design from years 1997–2005 into one dataset (4). For this analysis, estimates represent the midpoint of the time interval of the pooled data (2001) (4). Sample weights provided by NCHS were used to account for the sampling design and nonresponse.

The proportions of overweight, obesity (using each BMI standard), and diabetes were age- and sex-standardized to the 2000 U.S. population. Proportions were then compared across Asian subgroups and with non-Hispanic whites. Multivariable logistic regression was used to calculate odds ratios (ORs) for diabetes among Asian subgroups compared with non-Hispanic whites. Two-tailed P values of ≤0.05 were considered significant for all analyses. All analyses were done using SAS-callable SUDAAN software (version 9.0; Research Triangle Institute, Research Triangle Park, NC).

RESULTS

Overweight and obesity prevalence were higher in all Asian subgroups and among non-Hispanic whites when using the WHO Asian standard compared with the general standard. Regardless of standard, Asian Indians and Filipinos had statistically similar proportions of overweight and obese subjects but significantly higher proportions than either the Chinese or other Asian categories (P < 0.05) (supplemental table available in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc09-0573/DC1). Non-Hispanic whites had the highest proportions of obese individuals (P < 0.05) (supplemental table).

Across either BMI standard, Asian Indians had the highest diabetes prevalence compared with all other Asian subgroups and non-Hispanic whites (P < 0.05 for each) (Table 1). Diabetes prevalence in other Asian subgroups and non-Hispanic whites was statistically similar within the different weight categories.

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Table 1

Diabetes prevalence by BMI standard and OR (95% CI) for diabetes by ethnic group

Adjusted only for age and sex and compared with non-Hispanic whites, Asian Indians were more likely to report diabetes (OR 2.0 [95% CI 1.5–2.6]), but other Asian groups were not (Table 1). After adjusting for BMI, Asian Indians (3.1 [2.4–4.0]), Chinese (1.5 [1.1–2.1]), and Filipinos (1.6 [1.3–2.2]) were each more likely to report diabetes than non-Hispanic whites.

CONCLUSIONS

Although the prevalence of overweight and obesity are a function of the BMI standard used, a consistent pattern of higher overweight prevalence was demonstrated in Asian Indians and Filipinos compared with Chinese. Regardless of the BMI standard used, higher proportions of Asian Indians reported diabetes compared with other Asian subgroups and whites. In addition, compared with non-Hispanic whites, Asian Indian ethnicity alone was associated with diabetes, and other Asian ethnicities were not. After adjusting for BMI, all Asian subgroups were more likely to have diabetes than non-Hispanic whites.

Associations between BMI and diabetes have been previously shown to be modified by ethnicity (5). Studies have shown that Filipinos have higher diabetes prevalence than Chinese (6). Asian Indians have higher prevalence of diabetes than several other subgroups, and the risk increases at lower BMI thresholds (5). Although we do not know why there are differences in diabetes prevalence across Asian subgroups, a possible explanation is the differential associations between quantity and distribution of adiposity and metabolic risk. For example, increased susceptibility to diabetes in Asian Indians compared with Europeans (7) despite lower BMIs (8) is attributed to central adiposity, which may be due to lifestyle and/or genetic/intrauterine pre-disposition.

The use of BMI as a measure of body proportion is a limitation because of its inability to provide information on body fat distribution and central adiposity. Continued routine use of BMI in research and clinical practice is related to logistical ease in collecting height and weight (measured or self-reported) data. The WHO Asian weight standard is viewed as acceptable when more precise measures of adiposity are not available; however, this study indicates that for Asian Indians, ethnicity alone may be as informative as BMI with regard to diabetes risk.

A limitation of this study is the use of self-reported data, including self-reported height, weight, and diabetes. Although undiagnosed diabetes cannot be assessed using NHIS, a study in New York found that Asians had a rate of undiagnosed diabetes similar to that of non-Hispanic whites (9). As a result, the current study most likely underestimates the total diabetes prevalence in these populations. Furthermore, NHIS is a cross-sectional survey and does not include body weight at the time of diabetes diagnosis. The main strength of this study is the use of nationally representative data with a relatively large Asian sample.

In conclusion, this study demonstrates that Asian Indian ethnicity alone is associated with diabetes risk. We also find that the utility of the WHO Asian weight standard as a marker of diabetes risk may not be equivalent across different Asian subgroups. Prospective studies assessing the complex relationships between body shape, size, fat distribution, and development of cardiometabolic diseases across heterogeneous Asian groups are needed.

Acknowledgments

This work was supported by Centers for Disease Control and Prevention (CDC) Grant/Cooperative Agreement number 1R36SH000008-01. The contents herein are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

No potential conflicts of interest relevant to this article were reported.

Parts of this study were presented in abstract form at the 69th annual Scientific Sessions of the American Diabetes Association, New Orleans, Louisiana, 5–9 June 2009.

The authors thank Solveig Argeseanu Cunningham, PhD, and Mary Beth Weber, MPH, for their thoughtful review of the manuscript.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received March 25, 2009.
    • Accepted May 22, 2009.
  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

  • © 2009 by the American Diabetes Association.

References

  1. ↵
    U.S. Census Bureau. Asian/Pacific American Heritage Month, May 2008 [article online]. Available from: http://www.census.gov/Press-Release/www/releases/archives/cb08ff-05.pdf. Accessed 24 March 2009
  2. ↵
    1. Bhansali A,
    2. Nagaprasad G,
    3. Agarwal A,
    4. Dutta P,
    5. Bhadada S
    . Does body mass index predict overweight in native Asian Indians? A study from a North Indian population. Ann Nutr Metab 2006; 50: 66– 73
    OpenUrlCrossRefPubMed
  3. ↵
    World Health Organization: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157– 163
    OpenUrlCrossRefPubMedWeb of Science
  4. ↵
    National Center for Health Statistics: Variance estimation and other analytic issues in the 1997–2005 NHIS (adapted from appendices III and VII of the 2005 NHIS Survey Description Document, and appendix III of the 2006 NHIS Survey Description Document) [article online]. Available from: http://www.cdc.gov/nchs/data/nhis/9705var.pdf. Accessed 24 March 2009
  5. ↵
    1. Nakagami T,
    2. Qiao Q,
    3. Carstensen B,
    4. Nhr-Hansen C,
    5. Hu G,
    6. Tuomilehto J,
    7. Balkau B,
    8. Borch-Johnsen K
    . Age, body mass index and type 2 diabetes-associations modified by ethnicity. Diabetologia 2003; 46: 1063– 1070
    OpenUrlCrossRefPubMedWeb of Science
  6. ↵
    1. Gomez SL,
    2. Kelsey JL,
    3. Glaser SL,
    4. Lee MM,
    5. Sidney S
    . Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organization. Am J Public Health 2004; 94: 1977– 1984
    OpenUrlCrossRefPubMedWeb of Science
  7. ↵
    1. McKeigue PM,
    2. Marmot MG
    . Mortality from coronary heart disease in Asian communities in London. BMJ 1988; 297: 903
    OpenUrlFREE Full Text
  8. ↵
    1. Raji A,
    2. Seely EW,
    3. Arky RA,
    4. Simonson DC
    . Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J Clin Endocrinol Metab 2001; 86: 5366– 5371
    OpenUrlCrossRefPubMedWeb of Science
  9. ↵
    1. Thorpe LE,
    2. Upadhyay UD,
    3. Chamany S,
    4. Garg R,
    5. Mandel-Ricci J,
    6. Kellerman S,
    7. Berger DK,
    8. Frieden TR,
    9. Gwynn C
    . Prevalence and control of diabetes and impaired fasting glucose in New York City. Diabetes Care 2009; 32: 57– 62
    OpenUrlAbstract/FREE Full Text
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Asian Americans: Diabetes Prevalence Across U.S. and World Health Organization Weight Classifications
Reena Oza-Frank, Mohammed K. Ali, Viola Vaccarino, K.M. Venkat Narayan
Diabetes Care Sep 2009, 32 (9) 1644-1646; DOI: 10.2337/dc09-0573

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Asian Americans: Diabetes Prevalence Across U.S. and World Health Organization Weight Classifications
Reena Oza-Frank, Mohammed K. Ali, Viola Vaccarino, K.M. Venkat Narayan
Diabetes Care Sep 2009, 32 (9) 1644-1646; DOI: 10.2337/dc09-0573
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