Ethnicity, Obesity, and Risk of Type 2 Diabetes in Women

Abstract

OBJECTIVE -To examine ethnic differences in risk of type 2 diabetes, taking dietary and lifestyle risk factors into account. -A prospective (1980 -2000) cohort (from The Nurses' Health Study) including 78,419 apparently healthy women (75,584 whites, 801 Asians, 613 Hispanics, and 1,421 blacks) was studied. Detailed dietary and lifestyle information for each participant was repeatedly collected every 4 years. CONCLUSIONS -The risk of diabetes is significantly higher among Asians, Hispanics, and blacks than among whites before and after taking into account differences in BMI. Weight gain is particularly detrimental for Asians. Our data suggest that the inverse association of a healthy diet with diabetes is stronger for minorities than for whites. RESEARCH DESIGN AND METHODS RESULTS Diabetes Care 29:1585-1590, 2006E thnic differences in prevalence of type 2 diabetes are well documented. In 2004, the prevalence of diagnosed diabetes in the U.S. was higher for blacks and Hispanics than for whites across all age-groups (1). For women aged 45-64 years, the prevalence was 7.8% among whites, 13.5% among Hispanics, and 15.4% among blacks. From 1980 through 2004, the age-adjusted prevalence increased by 65% among white women and 37% among black men (1-5). A random sample of 5% of Medicare feefor-service beneficiaries Ն65 years of age (6) showed the prevalence of type 2 diabetes to be the highest among Hispanics, the lowest among whites, and intermediate for blacks and Asians. The greatest increase in diabetes prevalence was observed among Asians (68%) during the 7-year period from 1997 to 2004 (6). In a recent population-based national U.S. telephone survey (7), the prevalence of diabetes was significantly higher among Asian Americans than among nonHispanic whites, after accounting for a lower BMI among Asians.Diabetes is primarily determined by obesity and lifestyle factors such as diet and exercise (8). However, no previous study has examined whether these factors can explain ethnic differences in prevalence of diabetes. Therefore, we conducted a prospective analysis of ethnic differences in type 2 diabetes risk among 78,419 apparently healthy middle-aged women in the Nurses' Health Study during 20 years of follow-up.A unique feature of this study is the detailed information on diet and lifestyle factors that has been repeatedly obtained during follow-up. RESEARCH DESIGN AND METHODSThe Nurses' Health Study population The Nurses' Health Study cohort was established in 1976 when 121,700 female registered nurses, aged 30 -55 years and residing in 11 states, completed a mailed questionnaire about their medical history and lifestyle. Follow-up questionnaires have been sent every 2 years to update information on potential risk factors and to identify newly diagnosed cases of cancer, coronary heart disease, diabetes, and other medical conditions. For the present analysis, we used information from respondents to the 1980 questionnaire, when we first inquired about diet. We excluded women who reported a diagnosis of diabetes, ca...

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