David Gee (Food Science and Nutrition), Dominic Klyve (Mathematics)
Diabetes is the seventh leading cause of death in the US and its prevalence is rising. Physicians commonly use a patient’s BMI or waist circumference (WC) for evaluating abdominal obesity (AO) as these have both been associated with diabetes risk. This study used the National Health And Nutrition Examination Survey database from 2011-2018 (n=20,052) and showed that a higher percentage of Asian American (AA) adults have diabetes compared to non-Asians (nA) (14.6% vs 12.1%, p=0.004), despite a far lower prevalence of obesity (14% vs 40%, p<0.001) and lower mean WC (88.7cm vs 100.5cm, p<0.001). The prevalence of diabetes was three times greater in normal weight (NW) AA’s (11%) than NW nA’s (4%). This study also evaluated whether WC compared to waist to height ratio (WHtR), which measures AO relative to height, better predicts diabetes in AA and nA’s. Among Asians, WC had a much lower sensitivity (46% of AA’s with diabetes have a high WC) compared to WHtR (89% of AA’s with diabetes have a high WHtR), meaning that WHtR correctly predicts far more patients with diabetes than WC does. The sensitivity of both WC and WHtR for nA’s was similar and high (84% and 88%, respectively). When stratified by BMI categories, WHtR was found to be eight times more sensitive predicting diabetes among NW AA’s compared to WC (86.1% vs 10.7%). Therefore, WHtR is more accurate in assessing AO compared to WC among AA’s, especially in the NW BMI category, and should be used in a physicians’ practice.
Keywords: Diabetes, NHANES, Asian Americans