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Research on Lower BMI Screening Recommendations in Asians

In December, the ADA reduced its BMI threshold for diagnosing type 2 diabetes in Asian Americans to ≥23 kg/m2.…

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Note: This article was published before the lowered cutpoint and provides some evidence supporting the decision.

According to the WHO, it has been estimated that by 2030, 7 out of 10 countries with the greatest burden of diabetes cases will be in Asia. There have been similar trends in the U.S. showing that Pacific Islanders, Filipinos, and South Asians had the highest prevalence and incidence of type 2 diabetes. Type 2 diabetes is occurring in the Asian-American population despite low BMI.

The Current American Diabetes Association (ADA) guidelines suggest that diabetes screening should be considered in asymptomatic adults, who are overweight (BMI ≥25 kg/m2) and have one or more known risk factors for diabetes, which includes Asian ethnicity. Since the recommended screening cut point for diabetes is ≥ 25 kg/m2 this could be an issue when a large majority of Asian-Americans have a BMI of < 25 kg/m2. This study is to determine an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis.

Cross-sectional data was used from 1,663 participants enrolled in four different U.S. cohort studies, ages ≥45 years, without a prior diabetes diagnosis. The data was pulled from population and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Participants were of South Asian, Filipino, Japanese, Chinese, Korean, or mixed Asian ancestry, without non- Asian admixture. Clinical measure used throughout the studies were; an administered 2-hr 75g oral glucose tolerance test (OGTT), BMI, and A1c.

Descriptive analyses were performed and presented as percentages or means, respectively. Mean values of continuous covariates were compared using independent Student t tests or ANOVA in unadjusted comparisons and general linear models in age adjusted comparisons. Pearson x2 test was used for categorical variables. P <0.05 were considered statistically significant. The BMI range was selected to include BMI values recommended by the World Health Organization to define overweight 23 kg/m2 and obesity 27.5 kg/m2 among Asians.

The mean age of the participants in the study was 59.7 years, mean BMI was 25.4 kg/m2. Average BMI was similar by ethnicity among men but was significantly lower among Japanese women compared with either Filipinos or South Asian women and was significantly lower among Filipino women when compared with South Asian women. Approximately 58% were women, and type 2 diabetes prevalence was16.9%. When BMI ≥25 kg/m2 the sensitivity was 63.7%, and specificity 52.8%. From these results it was concluded that limiting screening to BMI ≥25 kg/m2 would miss the diagnosis of 36% of Asian Americans with type 2 diabetes. When BMI was ≥23 kg/m2, the sensitivity which was 84.7% was high in the total sample, gender, and Asian-American subgroup. This determines that cutting the BMI by 2 points in this population would miss only ∼15% of Asian Americans with diabetes.

Maria Rosario G. Araneta, Alka M.Kanaya, William C.Hsu, et al. "Optimum BMI Cut Points to Screen Asian Americans for Type 2 Diabetes". Diabetes Care, Feb 9, 2015