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

Abstract

OBJECTIVETo compare diabetes prevalence among Asian Americans by World Health Organization and U.S. BMI classifications.RESEARCH DESIGN AND METHODSData 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.RESULTSRegardless 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.CONCLUSIONSAsian 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.

Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations

“…This problem is especially relevant for populations of East Asian and South Asian origin. On the basis of the National Health Interview Survey, Oza-Frank et al 61 reported that using the current BMI thresholds of overweight at 25 kg/m 2 and obesity at 30 kg/m 2 , the proportions of Asian Americans who met the criteria for overweight and obese were just 29% and 7%, respectively, significantly lower than for the US population as a whole. As discussed above, however, Asians and Asian Americans have substantially higher levels of adiposity at the same BMI as non-Hispanic whites, and they also develop cardiovascular risks at lower levels of BMI.…”

“…62 For these reasons, a WHO Expert Consultation recommended lower BMI thresholds for overweight and obesity among Asians. A comparison of these lower thresholds to the current US standards provides an estimate of the proportion of overweight and obesity that is missed if the thresholds of 25 and 30 kg/m 2 are applied to different Asian groups 61 ( Table 1).…”

Different Associations of Diabetes With β-Cell Dysfunction and Insulin Resistance Among Obese and Nonobese Chinese Women With Prior Gestational Diabetes Mellitus

“…Several studies suggested that in white people, obese diabetic patients displayed peripheral insulin resistance in combination with b-cell dysfunction, whereas nonobese diabetic patients showed only a secretory defect (6). It has been shown that Asians and Asian Americans are more likely to develop GDM and diabetes, although they generally have lower BMI levels than whites (7,9). Two good explanations might be that Asians have higher adiposity per unit BMI (22) and have decreased insulin sensitivity and especially increased b-cell dysfunction compared with whites (10).…”

“…Some studies suggested that among a white population, obese diabetic patients displayed peripheral insulin resistance in combination with defective insulin secretion, whereas nonobese diabetic patients showed only a secretory defect (6). Yet because Asians and Asian emigrants generally have lower BMI, similar or even higher prevalence of diabetes (7)(8)(9), and decreased insulin sensitivity and b-cell dysfunction (10) compared to whites, an ethnic difference underlying the pathogenesis of diabetes seems to exist. Moreover, few studies have focused on b-cell dysfunction and insulin resistance among women with a history of GDM.…”

Income-related differences in mortality among people with diabetes mellitus

“…25 New immigrants often earn less income than longer-term residents, and people of South Asian origin in particular are more susceptible to diabetes and cardiovascular complications. 26,27 Although increasing socioeconomic inequalities in mortality have been documented in other developed countries, 10,11 Canada has seen a narrowing of income-related differences in mortality overall since the advent of universal health care. 8 In contrast, we found a widening gap in income-related differences in mortality among people with diabetes.…”