Abstract
Despite having lower body mass index (BMI) compared to other ethnic groups, Asians continue to develop significant metabolic diseases such as hypertension and diabetes. To evaluate the disparate association of BMI and risk of hypertension and diabetes in Asians. We retrospectively studied 150,753 adults from the 1985–2011 California Behavioral Risk Factor Survey. Trends in prevalence of obesity, hypertension, and diabetes were stratified by ethnicity. Multivariate logistic regression models evaluated the incremental effect of one unit BMI increase on risk of hypertension and diabetes and the disparate risks of hypertension and diabetes at different BMI thresholds. Asians had the lowest BMI among all groups. However, the impact of increasing BMI on risk of hypertension and diabetes was significantly greater in Asians. For each one unit increase in BMI, Asians were significantly more likely to have hypertension (OR 1.15; 95 % CI 1.13–1.18) compared to non-Hispanic whites, blacks, and Hispanics. Similar trends were seen for diabetes (Asians: OR 1.15; 95 % CI 1.13–1.18). The risk of hypertension in Asians with BMI ≥ 22 was similar to non-Hispanic whites with BMI ≥ 27 and blacks with BMI ≥ 28. The risk of diabetes in Asians with BMI ≥ 28 was similar to non-Hispanic whites with BMI ≥ 30. Despite lower overall BMI compared to other groups, weight gain in Asians is associated with significantly higher risks of hypertension and diabetes. Compared to other ethnic groups, similar risks of hypertension and diabetes are seen in Asians at much lower BMI.
Similar content being viewed by others
References
Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. Journal of the American Medical Association, 307(5), 491–497.
Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999–2008. Journal of the American Medical Association, 303(3), 235–241.
Adams, K. F., Schatzkin, A., Harris, T. B., Kipnis, V., Mouw, T., Ballard-Barbash, R., et al. (2006). Overweight, obesity, and mortality in a large prospective cohort of persons 50–71 years old. New England Journal of Medicine, 355(8), 763–778.
Must, A., Spadano, J., Coakley, E. H., Field, A. E., Colditz, G., & Dietz, W. H. (1999). The disease burden associated with overweight and obesity. Journal of the American Medical Association, 282(16), 1523–1529.
Palaniappan, L. P., Carnethon, M. R., & Fortmann, S. P. (2002). Heterogeneity in the relationship between ethnicity, BMI, and fasting insulin. Diabetes Care, 25, 1351–1357.
Palaniappan, L., Carnethon, M. R., Wang, Y., Hanley, A. J. G., Fortmann, S. P., Haffner, S. M., et al. (2004). Predictors of the incident metabolic syndrome in adults. Diabetes Care, 27, 788–793.
Palaniappan, L. P., Wong, E. C., Shin, J. J., Fortmann, S. P., & Lauderdale, D. S. (2011). Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index. International Journal of Obesity: Journal of the International Association for the Study of Obesity, 35(3), 393–400.
Zhang, H., & Rodriguez-Monguio, R. (2012). Racial disparities in the risk of developing obesity-related diseases: a cross-sectional study. Ethnicity and Disease, 22(3), 308–316.
Kershaw, K. N., Albrecht, S. S., & Carnethon, M. R. (2013). Racial and ethnic residential segregation, the neighborhood socioeconomic environment, and obesity among Blacks and Mexican Americans. American Journal of Epidemiology, 177(4), 299–309.
Jackson, C. L., Szklo, M., Yeh, H. C., Wang, N. Y., Dray-Spira, R., Thorpe, R., et al. (2013). Black–white disparities in overweight and obesity trends by educational attainment in the United States, 1997–2008. Journal of obesity, 2013, 140743.
Taveras, E. M., Gillman, M. W., Kleinman, K. P., Rich-Edwards, J. W., & Rifas-Shiman, S. L. (2013). Reducing racial/ethnic disparities in childhood obesity: The role of early life risk factors. Journal of the American Medical Association Pediatrics, 3, 1–7.
Ghirardelli, A., Quinn, V., & Foerster, S. B. (2010). Using geographic information systems and local food store data in California’s low-income neighborhoods to inform community initiatives and resources. American Journal of Public Health, 100(11), 2156–2162.
Acheampong, I., & Haldeman, L. (2013). Are nutrition knowledge, attitudes, and beliefs associated with obesity among low-income Hispanic and African American women caretakers? Journal of Obesity, 2013, 123901.
Babey, S. H., Hastert, T. A., Wolstein, J., & Diamant, A. L. (2010). Income disparities in obesity trends among California adolescents. American Journal of Public Health, 100(11), 2149–2155.
Claire Wang, Y., Gortmaker, S. L., & Taveras, E. M. (2011). Trends and racial/ethnic disparities in severe obesity among US children and adolescents, 1976–2006. International Journal of Pediatric Obesity: IJPO: An Official Journal of the International Association for the Study of Obesity, 6, 12–20.
Van Hulst, A., Gauvin, L., Kestens, Y., Barnett, TA. (2013). Neighborhood built and social environment characteristics: A multilevel analysis of associations with obesity among children and their parents. International Journal of Obesity: Journal of the International Association for the Study of Obesity, PMID, 23736374. E-pub ahead of print.
Slack, T., Myers, CA., Martin, CK., Heymsfield, SB. (2013). The geographic concentration of US adult obesity prevalence and associated social, economic, and environmental factors. Obesity (Silver Spring), PMID, 23630100. E-pub ahead of print.
Wang, J., Thornton, J. C., Russell, M., Burastero, S., Heymsfield, S., & Pierson, R. N, Jr. (1994). Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. American Journal of Clinical Nutrition, 60(1), 23–28.
Jain, A., Mitchell, S., Chirumamilla, R., Zhang, J., Horn, I. B., Lewin, A., et al. (2012). Prevalence of obesity among young Asian-American children. Childhood Obesity, 8(6), 518–525.
Flegal, K. M., Shepherd, J. A., Looker, A. C., Graubard, B. I., Borrud, L. G., Ogden, C. L., et al. (2009). Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. American Journal of Clinical Nutrition, 89(2), 500–508.
Aloia, J. F., Vaswani, A., Mikhail, M., & Flaster, E. R. (1999). Body composition by dual-energy X-ray absorptiometry in black compared with white women. Osteoporosis International, 10(2), 114–119.
Fernández, J. R., Heo, M., Heymsfield, S. B., Pierson, R. N, Jr, Pi-Sunyer, F. X., Wang, Z. M., et al. (2003). Is percentage body fat differentially related to body mass index in Hispanic Americans, African Americans, and European Americans? American Journal of Clinical Nutrition, 77(1), 71–75.
Rahman, M., Temple, J. R., Breitkopf, C. R., & Berenson, A. B. (2009). Racial differences in body fat distribution among reproductive-aged women. Metabolism, 58(9), 1329–1337.
Du, T., Sun, X., Yin, P., Huo, R., Ni, C., & Yu, X. (2013). Increasing trends in central obesity among Chinese adults with normal body mass index, 1993–2009. BioMed Central Public Health, 13, 327.
Beltrán-Sánchez, H., Harhay, MO., Harhay, MM., McElligott, S. (2013). Prevalence and trends of metabolic syndrome in the adult US population, 1999–2010. Journal of the American College of Cardiology, PMID, 23810877. E-pub ahead of print.
Ko, G. T., & Chan, J. C. (2008). Burden of obesity–lessons learnt from Hong Kong Chinese. Obesity Reviews, 9(Suppl 1), 35–40.
Huang, K. C. (2008). Obesity and its related diseases in Taiwan. Obesity Reviews, 9(Suppl 1), 32–34.
Misra, A., & Khurana, L. (2011). Obesity-related non-communicable diseases: South Asians versus White Caucasians. International Journal of Obesity: Journal of the International Association for the Study of Obesity, 35(2), 167–187.
Bonnie Davis, Marta Induni, and Maricsa Gutierrez (2012). California behavioral risk factor survey SAS dataset documentation and technical report: 1984–2011. Survey Research Group, California Department of Public Health.
Waksberg, J. S. (1978). Sampling methods for random digit dialing. Journal of American Statistical Association, 73, 40–46.
Centers for Disease Control and Prevention (CDC) (2009). Overweight and obesity. Department of Health and Human Services. Atlanta, GA: Defining Overweight and Obesity.
Han, T. S., Williams, K., Sattar, N., Hunt, K. J., Lean, M. E., & Haffner, S. M. (2002). Analysis of obesity and hyperinsulinemia in the development of metabolic syndrome: San Antonio heart study. Obesity Research, 10, 923–931.
Laaksonen, D. E., Lakka, H.-M., Niskanen, L. K., Kaplan, G. A., Salonen, J. T., & Lakka, T. A. (2002). Metabolic syndrome and development of diabetes mellitus: Application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. American Journal of Epidemiology, 156, 1070–1077.
National Cholesterol Education Program (NCEP) (2002). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), Final Report. National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH).
Alexander, C. M., Landsman, P. B., Teutsch, S. M., & Haffner, S. M. (2003). NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes, 52, 1210–1214.
Carnethon, M. R., Palaniappan, L. P., Burchfiel, C. M., Brancati, F. L., & Fortmann, S. P. (2002). Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults: the atherosclerosis risk in communities study: 1987–1998. Diabetes Care, 25, 1358–1364.
Kohli, S., Lear, SA. (2012). Differences in subcutaneous abdominal adiposity regions in four ethnic groups. Obesity (Silver Spring), PMID, 23703792. E-pub ahead of print.
James, W. P., Chunming, C., & Inoue, S. (2002). Appropriate Asian body mass indices? Obesity Reviews, 3, 139.
WHO Expert Consultation. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363, 157–163.
World Health Organization Western Pacific Region, International Association for the Study of Obesity and the International Obesity Task Force. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Health Communications Australia Pty Limited: Sydney, 2000, ISBN 0–9577082-1-1.
Shao, J., Yu, L., Shen, X., Li, D., & Wang, K. (2010). Waist-to-height ratio, an optimal predictor for obesity and metabolic syndrome in Chinese adults. The journal of nutrition, health and aging, 14(9), 782–785.
Liu, Y., Tong, G., Tong, W., Lu, L., & Qin, X. (2011). Can body mass index, waist circumference, waist-hip ratio and waist-height ratio predict the presence of multiple metabolic risk factors in Chinese subjects? BioMed Central Public Health, 11, 35.
Worachartcheewan, A., Dansethakul, P., Nantasenamat, C., Pidetcha, P., & Prachayasittikul, V. (2012). Determining the optimal cutoff points for waist circumference and body mass index for identification of metabolic abnormalities and metabolic syndrome in urban Thai population. Diabetes Research and Clinical Practice, 98(2), e16–e21.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wong, R.J., Chou, C., Sinha, S.R. et al. Ethnic Disparities in the Association of Body Mass Index with the Risk of Hypertension and Diabetes. J Community Health 39, 437–445 (2014). https://doi.org/10.1007/s10900-013-9792-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-013-9792-8