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Article Title

Higher Prevalence of Insulin Resistance Among Asian Americans Despite Lower Body Mass Index

Publication Date

4-30-2015

Keywords

insulin resistance, racial/ethnic differences

Abstract

Background/Aims: This study aims to identify racial/ethnic differences in the relationship between body mass index (BMI) and insulin resistance across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Mexicans, non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) in a large, mixed-payer ambulatory care setting in northern California.

Methods: This cross-sectional study examined electronic health records of patients aged 18 years or older from 2000–2012. Insulin resistance was indicated by triglyceride/high-density lipoprotein ratio > 3. Overweight or obesity was defined as BMI ≥ 25.

Results: Although Asian Americans had the lowest rate of overweight and obesity, they had the highest prevalence of insulin resistance in both normal weight (19%, 9,262 of 49,981) and overweight/obese groups (43%, 15,742 of 36,496), followed by Mexicans (normal: 12%, 197 of 1,590; overweight: 39%, 2,106 of 5,377), NHWs (normal: 9%, 6,271 of 65,921; overweight: 32%, 33,475 of 103,695) and NHBs (normal: 6%, 46 of 716; overweight: 16%, 459 of 2,855). After controlling for age, gender and important comorbidities (presence of high blood pressure, hyperglycemia, dyslipidemia), Asian Americans were still significantly more likely to have insulin resistance in both BMI groups (normal: 1.6 odds ratio [OR], 1.5–1.7 confidence interval [CI]; overweight: 1.3 OR, 1.2–1.4 CI) compared to NHWs. Significant racial/ethnic differences in insulin resistance were also found across Asian American subgroups. Among normal weight patients, Asian Indians (OR: 2.1, CI: 2.0–2.2), Chinese (OR: 1.4, CI: 1.3–1.5) and Filipinos (OR: 1.3, CI: 1.1–1.5) were significantly more likely to have insulin resistance compared to NHWs after controlling for age, gender and comorbidities. Higher adjusted risk of insulin resistance was also observed among Asian Indians (OR: 1.5, CI: 1.4–1.6) and Chinese (OR: 1.3, CI: 1.2–1.4) overweight/obese patients, while other Asian subgroups had no significant difference compared to NHWs.

Discussion: Asian Americans are more likely to have insulin resistance despite lower rates of overweight and obesity. Our study suggests the use of lower BMI when screening for insulin resistance among Asian Americans.

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