Objective: BMI and waist circumference are used to define risk from excess body fat. Limited data in women suggest that there may be racial/ethnic differences in visceral adipose tissue (VAT) at a given BMI or waist circumference. This study tested the hypothesis that racial/ethnic differences exist in both men and women in the relationship of anthropometric measures of body composition and computed tomography (CT)-determined VAT or subcutaneous adipose tissue (SAT). Methods and Procedures: Subjects included 66 African American, 72 Hispanic, and 47 white men and women, aged ≥45. Waist circumference and BMI were measured using standard methods. Total abdominal and L4L5 VAT and SAT were measured using CT. Results: Among both men and women, groups did not differ in waist circumference or BMI. White men had greater L4L5 VAT than African-American men, and both white and Hispanic men had greater total VAT than African-American men. Among women, Hispanics and whites had greater L4L5 VAT than African Americans, and Hispanics had greater total VAT than African Americans. The slope of the linear relationship between BMI or waist circumference and VAT was lower in African Americans than in Hispanics and/or whites. Discussion: Middle-aged and older African-American men and women had lower VAT despite similar BMI and waist circumference measurements. Altered relationships between anthropometric measures and VAT may have implications for defining metabolic risk in different populations. Different waist circumference or BMI cutoff points may be necessary to adequately reflect risk in different racial/ethnic groups.

The purpose of this study was to determine whether racial/ethnic differences exist in the relationship between visceral adipose tissue (VAT) and selected inflammatory biomarkers. Subjects included 136 African‐American, 133 Hispanic, and 100 white men and women, aged ≥45. Waist circumference and BMI were measured using standard methods. Total VAT, and VAT and subcutaneous adipose tissue (SAT) at the L4L5 spinal level were measured using computed tomography. Interleukin‐6 (IL‐6), C‐reactive protein (CRP), and fibrinogen were measured from fasting blood samples. Results revealed that waist circumference and BMI were similar among groups but African Americans had significantly lower L4L5 VAT compared with Hispanics and whites. Despite lower VAT, African‐American men had similar concentrations of inflammatory biomarkers. On the other hand, African‐American women had higher CRP and IL‐6 than white women, and higher fibrinogen than both Hispanic and white women. After controlling for L4L5 VAT, L4L5 SAT, and age, African‐American women had higher concentrations of IL‐6 and fibrinogen. Stratified analyses for CRP indicated that L4L5 SAT was associated with CRP in African‐American and white women after controlling for L4L5 VAT and age, but that the reverse was not true. These data indicate that African Americans had lower VAT but similar or higher concentrations of inflammatory biomarkers. African‐American women consistently displayed greater inflammation compared with whites, even after controlling for VAT or SAT.

Research has shown that experiences of discrimination negatively affect health. However, little is known about whether socioeconomic position modifies the reporting of perceived discrimination. This cross-sectional study of 69 participants investigated the modifying effects of education and income on the reporting of perceived discrimination among Hispanics and Whites. Hispanics, compared to non-Hispanic Whites, of higher education (more than high school) and income ($30,000 or more per year) status are more than 4 times more likely to report perceived discrimination (odds ratio [OR] = 4.09, 95% confidence interval [CI] = 1.31-12.72; OR = 4.43, 95% CI = 1.41-13.93, respectively). However, this difference was nonsignificant among those with lower education and income levels (OR = 1.71, 95% CI = 0.27-10.92; OR = 1.71, 95% CI = 0.20-15.02, respectively). These results may affect future study sample and effect sizes.

This article, the first in a series of six articles, introduces the concept of evidence-based medicine and describes the first two steps of practicing it: formulating an answerable clinical question and searching the available evidence. The types of clinical questions practitioners can ask are examined and a hierarchy of how to search for the best and most authoritative evidence is provided. The skills learned from creating an answerable question and searching the evidence, as outlined in this article, provide a solid basis for life-long learning and improved patient care.

Racial and ethnic health disparities inarguably exist in the United States. It is important to educate primary care clinicians regarding this topic because they have the ability to have an impact in the reduction of health disparities. This article presents the evidence that disparities exist, how clinicians contribute to these disparities, and what primary care clinicians can do to reduce disparities in their practice. Clinicians are able to impact health disparities by receiving and providing cross-cultural education, communicating effectively with patients, and practicing evidence-based medicine. The changes suggested herein will have an impact on the current state of health of our nation.