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Screening for cardiometabolic risk using obesity criteria overlooks racial/ethnic groups

Although many racial/ethnic minority groups have healthy body weight, they experience a higher risk for heart disease and diabetes that could not be explained by differences in demographic, behavioral or ectopic fat measures, according to a recent study.

“Some persons with normal weight have elevated cardiometabolic risk, and the relationship between excess adiposity and cardiometabolic abnormality may vary by race/ethnicity,” Unjali P. Gujral, PhD, from the global diabetes research center at Emory University, and colleagues wrote. “Although some information is available regarding the prevalence and correlates of metabolic abnormality but normal weight (MAN) in non-Hispanic whites, non-Hispanic African Americans, and Mexican Americans, no direct comparisons have been made among East or South Asians who are at high risk for cardiometabolic abnormalities, even at relatively low levels of body mass index.”

To compare the prevalence of MAN among members of five racial/ethnic groups, researchers designed a cross-sectional analysis using data from two community-based U.S. cohorts: the Multi-Ethnic Study of Atherosclerosis and the Mediators of Atherosclerosis in South Asians Living in America study. Participants included 846 whites, 334 blacks, 323 Chinese Americans, 252 Hispanics and 195 South Asians with normal body weight. They measured the prevalence of two or more cardiometabolic abnormalities among normal-weight participants and assessed correlates of MAN.

Gujral and colleagues found that among participants with normal body weight, the prevalence of MAN was 21% in whites (95% CI, 18.4-23.9), 32.2% in Chinese Americans (95% CI, 27.3-37.4), 31.1% in blacks (95% CI, 26.3-36.3), 38.5% in Hispanics (95% CI, 32.6-44.6) and 43.6% in South Asians (95% CI, 36.8-50.6). After adjustment for age, sex, and race/ethnicity–BMI interaction, for the equivalent MAN prevalence at a BMI of 25 kg/m² in whites, the corresponding BMI values were 22.9 kg/m² in blacks, 21.5 kg/m² in Hispanics, 20.9 kg/m² in Chinese Americans, and 19.6 kg/m² in South Asians. This high prevalence of cardiometabolic abnormality among normal weight racial/minority persons could not be explained by differences in demographic, behavioral, and ectopic body fat measures.

“Clinicians using overweight and obesity as the main criteria for cardiometabolic screening, as currently recommended by the U.S. Preventive Services Task Force for diabetes testing, may fail to identify cardiometabolic abnormalities in many patients from racial/ethnic minority groups,” Gujral and colleagues wrote. “Although the Task Force recommends earlier screening in racial/ethnic minority populations, testing for cardiometabolic abnormalities in normal-weight and underweight members of these groups also may be an important consideration.” – by Savannah Demko

Disclosure: Gujral reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.