Cardiometabolic Abnormalities Among Normal-Weight Persons From Five Racial/Ethnic Groups in the United States

Abstract

Background The relationship between body weight and cardiometabolic disease may vary substantially by race/ethnicity. Objective To determine the prevalence and correlates of the phenotype of metabolic abnormality but normal weight (MAN) for 5 racial/ethnic groups. Design Cross-sectional analysis. Setting 2 community-based cohorts. Participants 2622 white, 803 Chinese American, 1893 African American, and 1496 Hispanic persons from MESA (Multi-Ethnic Study of Atherosclerosis) and 803 South Asian participants in the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study. Measurements Prevalence of 2 or more cardiometabolic abnormalities (high fasting glucose, low high-density lipoprotein cholesterol, and high triglyceride levels and hypertension) among normal-weight participants was estimated. Correlates of MAN were assessed by using log-binomial models. Results Among normal-weight participants (n = 846 whites, 323 Chinese Americans, 334 African Americans, 252 Hispanics, and 195 South Asians), the prevalence of MAN was 21.0% (95% CI, 18.4% to 23.9%) in whites, 32.2% (CI, 27.3% to 37.4%) in Chinese Americans, 31.1% (CI, 26.3% to 36.3%) in African Americans, 38.5% (CI, 32.6% to 44.6%) in Hispanics, and 43.6% (CI, 36.8% to 50.6%) in South Asians. Adjustment for demographic, behavioral, and ectopic body fat measures did not explain racial/ethnic differences. After adjustment for age, sex, and race/ethnicity–body mass index (BMI) interaction, for the equivalent MAN prevalence at a BMI of 25.0 kg/m2 in whites, the corresponding BMI values were 22.9 kg/m2 (CI, 19.5 to 26.3 kg/m2) in African Americans, 21.5 kg/m2 (CI, 18.5 to 24.5 kg/m2) in Hispanics, 20.9 kg/m2 (CI, 19.7 to 22.1 kg/m2) in Chinese Americans, and 19.6 kg/m2 (CI, 17.2 to 22.0 kg/m2) in South Asians. Limitation Cross-sectional study design and lack of harmonized dietary data between studies. Conclusion Compared with whites, all racial/ethnic minority groups had a statistically significantly higher prevalence of MAN, which was not explained by demographic, behavioral, or ectopic fat measures. Using a BMI criterion for overweight to screen for cardiometabolic risk may result in a large proportion of racial/ethnic minority groups being overlooked. Primary Funding Source National Institutes of Health.

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

“…Obesity was defined as BMI 18.5-23.9 kg/m 2 and metabolic abnormality referenced at least two abnormal traits among the factors of TG, HDL-C, BP and FPG. Using the same definition of metabolic risk, the Multi-Ethnic Study of Atherosclerosis showed high variability in the prevalence of metabolically unhealthy with normal-weight individuals based on ethnicity: The prevalence was 21.0% in Whites, 32.2% in Chinese Americans, 31.1% in African Americans, 38.5% in Hispanics, and 43.6% in South Asians [21]. The prevalence among Chinese was highly consistent between our findings in mainland China and the findings in America.…”

Global patterns in excess body weight and the associated cancer burden

“…The BMI categories for overweight and obesity used by the WHO are based on data primarily from populations of European origin living in high‐income countries. A WHO expert consultation concluded that substantial proportions of Asians with a high risk of type 2 diabetes and cardiovascular disease are classified as having a “normal” weight, suggesting that using the same categories for all racial/ethnic groups may result in overlooking a large proportion of at‐risk individuals in some populations …”

“…A WHO expert consultation concluded that substantial proportions of Asians with a high risk of type 2 diabetes and cardiovascular disease are classified as having a "normal" weight, 20 suggesting that using the same categories for all racial/ethnic groups may result in overlooking a large proportion of at-risk individuals in some populations. [21][22][23] Measurement of specific body fat compartments requires costly medical equipment. Computed tomography or magnetic resonance imaging currently provides the most accurate measures for whole-body fat mass as well as tissue and organ adiposity.…”

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“…Pima Indians, who have among the highest reported prevalence levels of diabetes worldwide over the last 50 years, also have high levels of obesity and insulin resistance compared with other ethnic groups, which may be due to both innate susceptibility as well as lifestyle . In stark contrast, Asian Indians generally exhibit a thin body mass index (BMI) phenotype with high risk of diabetes, experiencing a high prevalence levels of type 2 diabetes and at lower BMI levels compared with other ethnic groups.…”