Anthropometric risk factors for diabetes differ by ethnicity

November 21, 2018   /

By Will Boggs MD

NEW YORK (Reuters Health) - Waist circumference is the best predictor of diabetes risk across all racial/ethnic groups, but other anthropometric risk factors for the disorder vary with ethnicity and race, according to findings from the Women's Health Initiative (WHI).

"The most surprising for me was the finding that the anthropometric measures were all relatively weaker for African-American women," Dr. Juhua Luo from Indiana University, in Bloomington, told Reuters Health by email. "I was also surprised that waist circumference (WC) performed as well as it did against the body composition biomarkers."

Compared with white postmenopausal women in the U.S., black, Hispanic and Asian postmenopausal women have a twofold or higher risk of diabetes. Relatively little is known about how the utility of anthropometric measures as predictors of developing diabetes might differ by race/ethnicity.

For their study, online October 23 in Diabetes Care, Dr. Luo and colleagues used WHI data on more than 136,000 postmenopausal women. WC had the strongest associations with risk of diabetes, followed by BMI and then waist-to-hip ratio (WHR), across all racial and ethnic groups.

The links between WC and diabetes risk were strongest in Asian women and weakest in black women. The association between body composition measured by whole-body DXA and diabetes risk was also significantly modified by race/ethnicity.

Trunk fat had the highest hazard ratio for risk of diabetes in non-Hispanic white women, whereas trunk-to-leg fat ratio had the highest hazard ratio for black women.

Among Hispanic/Latina women, trunk fat and trunk-to-leg fat ratio were comparable predictors of diabetes risk.

For BMI, 25 and 30 kg/m2 were optimal cut points for predicting diabetes risk among non-Hispanic white, black and Hispanic women. Lower cut points for Asian women (24.5 and 27.0 kg/m2) and higher cut points for American Indian women (27.0 and 36.5 kg/m2) were better predictors.

The best WC cut points were 88-91 cm for non-Hispanic white, American Indian and Hispanic women, while lower cut points better predicted diabetes risk among black (84 cm) and Asian (79 cm) women.

Optimal cut points for WHR ranged from 0.76 to 0.85, values that are lower than the currently recommended cut point (0.85) based on WHO abdominal obesity measurement guidelines for all racial and ethnic groups other than Hispanic (whose optimal cut point using these data was 0.85).

"We can continue to rely on easily measured indicators like WC, as it performed so well relative to body composition tests," Dr. Luo said.

"Further research should examine whether cut points should be lower for WHR," the researchers add. "Better anthropometric measures that reflect the trunk-to-leg fat ratio may improve risk assessment for diabetes among black women."


Diabetes Care 2018.

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