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Original Research Communication |
1 From the Department of Medicine, the University of Washington School of Medicine, Seattle; the Department of Anthropology, the University of Washington, Seattle; and the Veterans Affairs Epidemiologic Research Information Center, Seattle.
Background: Despite having lower average body mass indexes (BMIs) than do whites, Asians are at high risk of type 2 diabetes, possibly because of their greater central adiposity. The criteria for identifying individuals at risk of obesity-related conditions are usually not population specific.
Objective: Our goal was to determine whether the National Heart, Lung, and Blood Institute (NHLBI) overweight and obesity guidelines are useful for identifying diabetes risk in Japanese Americans.
Design: This was a prospective, cohort study of 466 nondiabetic Japanese Americans [age: 52.2 ± 0.6 y; BMI (in kg/m2): 24.1 ± 0.2; 
± SEM]. Diabetes status at a 5-y follow-up visit was assessed with an oral-glucose-tolerance test.
Results: Among 240 subjects aged 
55 y, incident diabetes was strongly associated with overweight (BMI 
25) at baseline [relative risk (RR): 22.4; 95% CI: 2.7, 183; adjusted for age, sex, smoking, and family history] and weight gain of >10 kg since the age of 20 y (adjusted RR: 4.5; 95% CI: 1.4, 14.5). NHLBI definitions of central obesity (waist circumference 88 cm for women and 102 cm for men) were unsuitable for this population because only 15 of 240 subjects met these criteria. A waist circumference greater than or equal to the third tertile was associated with diabetes (adjusted RR: 5.4; 95% CI: 1.7, 17.0). Among 226 subjects aged >55 y, incident diabetes was not associated with BMI, weight gain, or waist circumference.
Conclusions: NHLBI definitions are useful for identifying overweight Japanese Americans aged <55 y who are at high risk of diabetes. Although central adiposity is an important risk factor, the guidelines for waist circumference are insensitive predictors of diabetes risk in this population.
Key Words: Type 2 diabetes • Asian Americans • obesity • weight gain • body mass index • anthropometry • longitudinal study • central adiposity • National Heart • Lung • Blood Institute guidelines
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