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BMI Cut Points to Identify At-Risk Asian Americans for Type 2 Diabetes Screening
Open accessAbstract
According to the U.S. Census Bureau, an Asian is a person with origins from the Far East (China, Japan, Korea, and Mongolia), Southeast Asia (Cambodia, Malaysia, the Philippine Islands, Thailand, Vietnam, Indonesia, Singapore, Laos, etc.), or the Indian subcontinent (India, Pakistan, Bangladesh, Bhutan, Sri Lanka, and Nepal); each region has several ethnicities, each with a unique culture, language, and history.In 2011, 18.2 million U.S. residents self-identified as Asian American, with more than two-thirds foreign-born (1).In 2012, Asian Americans were the nation's fastestgrowing racial or ethnic group, with a growth rate over four times that of the total U.S. population.International migration has contributed .60% of the growth rate in this population (1).Among Asian Americans, the Chinese population was the largest (4.0 million), followed by Filipinos (3.4 million), Asian Indians (3.2 million), Vietnamese (1.9 million), Koreans (1.7 million), and Japanese (1.3 million).Nearly three-fourths of all Asian Americans live in 10 statesdCalifornia, New York, Texas, New Jersey, Hawaii, Illinois, Washington, Florida, Virginia, and Pennsylvania (1).By 2060, the Asian American population is projected to more than double to 34.4 million, with its share of the U.S. population climbing from 5.1 to 8.2% in the same period (2).
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“In the Asian population the prevalence of diabetes and cardiovascular disease is higher at a lower BMI than in the non-Asian population.”
From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [41]
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“It is well-established that Asian populations have a higher risk of developing diabetes at a lower body mass index (BMI) due to the higher predisposition to storing visceral fat than Caucasians (6).”
BackgroundRacial and Ethnic Differences in Anthropometric Measures as Risk Factors for Diabetes
Luo, J., HENDRYX, M. S., Laddu, D., Phillips, L. S., Chlebowski, R. T., LeBlanc, E. S., Allison, D. B., Nelson, D. A., Li, Y., Rosal, M. C., et al. (2018) · Diabetes Care · doi:10.2337/dc18-1413 · Cited by 65
“© 2018 by the American Diabetes Association.”
ResultInfluentialEthnic Differences in Risk Factors for Obesity among Adults in California, the United States
Wang, L., Southerland, J. L., Wang, K., Bailey, B. A., Alamian, A., Stevens, M., & Wang, Y. (2017) · Journal of Obesity · doi:10.1155/2017/2427483 · Cited by 69
“Due to small sample sizes for Pacific Islander (𝑛 = 73, 0.17%), American Indian/Alaskan native (𝑛 = 636, 1.48%), and other single/multiple racial groups (𝑛 = 3,065; 7.14%), we combined them as “other.””
InfluentialA Review of Cutoffs for Nutritional Biomarkers.
Raghavan, R., Sakr-Ashour, F. A., & Bailey, R. L. (2016) · Advances in Nutrition · doi:10.3945/an.115.009951 · Cited by 59
“, their risk of health conditions such as diabetes increases at a much lower BMI compared with non-Hispanic whites (45)].”
BackgroundLifestyle and socioeconomic determinants of diabetes: Evidence from country-level data
Richards, S. E., Wijeweera, C., & Wijeweera, A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0270476 · Cited by 69
“Current policy recommendations encourage setting a threshold BMI of� 23 kg/m2 to denote “overweight” in Chinese Asians [38].”
BackgroundInfluentialTakeno, K., Tamura, Y., Kawaguchi, M., Kakehi, S., Watanabe, T., Funayama, T., Furukawa, Y., Kaga, H., Yamamoto, R., Kim, M., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-1650 · Cited by 59
Yu, H., Ho, M. M., Liu, X., Yang, J., Chau, P. H., & Fong, D. (2022) · International Journal of Obesity · doi:10.1038/s41366-022-01096-1 · Cited by 70
“Notably, the Asian population had a much lower threshold of BMI for similar T2DM risk compared to the non-Asian population [20, 21].”
ResultAgbim, U., Carr, R., Pickett-Blakely, O., & Dagogo-Jack, S. (2019) · Current Obesity Reports · doi:10.1007/s13679-019-00349-x · Cited by 56
Bariatric/Metabolic Surgery in the Asia-Pacific Region: APMBSS 2018 Survey
Ohta, M., Seki, Y., Wong, S. K. H., Wang, C., Huang, C., Aly, A., Baijal, M., Al-Sabah, S. K., Udomsawaengsup, S., Heo, Y. S., et al. (2018) · Obesity Surgery · doi:10.1007/s11695-018-3539-7 · Cited by 63
Huang, S., Magny‐Normilus, C., McMahon, E. B., & Whittemore, R. (2021) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2021.10.007 · Cited by 74
Okura, T., Nakamura, R., Fujioka, Y., Kawamoto-Kitao, S., Ito, Y., Matsumoto, K., Shoji, K., Sumi, K., Matsuzawa, K., Izawa, S., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0201052 · Cited by 55
LeBlanc, K., Baer-Sinnott, S., Lancaster, K. J., Campos, H., Lau, K. H. K., Tucker, K. L., Kushi, L. H., & Willett, W. C. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100221 · Cited by 75
“Further, Asian Americans are at greater risk of developing type 2 diabetes at a lower BMI (in kg/m 2 ) compared with other groups [17].”
Amin, F., Fatima, S. S., Islam, N., & Gilani, A. H. (2015) · BMC Obesity · doi:10.1186/s40608-015-0044-6 · Cited by 48
“Therefore, using WC or BMI alone to classify individuals according to fatness may result in misclassification because of the varying contributions of body composition [10-12].”
MethodDiabetes Diagnosis and Control: Missed Opportunities to Improve Health
Cowie, C. C. (2019) · Diabetes Care · doi:10.2337/dci18-0047 · Cited by 64
“to consider diabetes testing for all Asian Americans with a BMI $23 kg/m(2) (8).”
BackgroundHruschka, D. J., & Hadley, C. (2016) · Obesity Reviews · doi:10.1111/obr.12449 · Cited by 58
Body Mass Index and Mortality in a Very Large Cohort: Is It Really Healthier to Be Overweight?
Klatsky, A. L., Zhang, J., Udaltsova, N. V., Li, Y., & Tran, H. (2017) · The Permanente Journal · doi:10.7812/tpp/16-142 · Cited by 59
Renal UTX-PHGDH-serine axis regulates metabolic disorders in the kidney and liver
Chen, H., Liu, C., Wang, Q., Xiong, M., Zeng, X., Yang, D., Xie, Y., Su, H., Zhang, Y., Huang, Y., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-31476-0 · Cited by 50
Ang, Q. Y., Alba, D., Upadhyay, V., Bisanz, J. E., Cai, J., Lee, H. L., Barajas, E., Wei, G., Noecker, C. A., Patterson, A. D., et al. (2021) · eLife · doi:10.7554/elife.70349 · Cited by 60
“Using IDEO, we recruited both lean and obese W and EA individuals 565 into this study based on World Health Organization cut-offs: W/EA BMI≤24.9 kg/m 2 (lean); W 566 BMI≥30 kg/m 2 (obese); and EA BMI≥27.5 kg/m 2 (obese) (Hsu et al., 2015; Jih et al., 2014; 567 WHO Expert Consultation, 2004).”
MethodInfluentialBouchi, R., Kondo, T., Ohta, Y., Goto, A., Tanaka, D., Satoh, H., Yabe, D., Nishimura, R., Harada, N., Kamiya, H., et al. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13960 · Cited by 56
Bissell, M. C. S., Kerlikowske, K. M., Sprague, B. L., Tice, J. A., Gard, C. C., Tossas, K. Y., Rauscher, G. H., Trentham‐Dietz, A., Henderson, L. M., Onega, T., et al. (2020) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-20-0358 · Cited by 75
“Using more conservative BMI cutoff points suggested for Asians (28) did not meaningfully change the HRs for breast cancer, but increased the proportion of overweight/obese women which slightly increased the PARPS.”
BackgroundMethodInfluentialBody Composition and Diabetes Risk in South Asians: Findings From the MASALA and MESA Studies
Flowers, E., Lin, F., Kandula, N. R., Allison, M., Carr, J. J., Ding, J., Shah, R. V., Liu, K., Herrington, D. M., & Kanaya, A. M. (2019) · Diabetes Care · doi:10.2337/dc18-1510 · Cited by 58
“Measuresof ectopic fat regions from computed tomography (CT) scans have demonstrated stronger associations with metabolic risk when comparedwithbodyweight or BMI in Asians (10,11,13).”
BackgroundSelf-citationJia, G., Shu, X., Liu, Y., Li, H.-L., Cai, H., Gao, J., Gao, Y.-T., Wen, W., Xiang, Y.-B., & Zheng, W. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.17371 · Cited by 48
The “A to Z” of Managing Type 2 Diabetes in Culturally Diverse Populations
Caballero, A. E. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00479 · Cited by 73
“Particular attention must be paid to Asian patients who may not be considered overweight or obese according to traditional standards but who tend to accumulate high levels of intra-abdominal or visceral fat leading to increased insulin resistance (34).”
BackgroundYang, J., Park, K. W., & Cho, S. (2018) · Journal of Biological Chemistry · doi:10.1074/jbc.ra118.002405 · Cited by 54
“In addition, a significantly higher incidence of undiagnosed diabetes in Asians (48) suggests that a treatment strategy targeting populations genetically at risk for developing obesity-associated metabolic dysfunction may be beneficial.”
BackgroundInfluentialAggarwal, R., Bibbins-Domingo, K. B., Yeh, R. W., Song, Y., Chiu, N., Wadhera, R. K., Shen, C., & Kazi, D. S. (2022) · Annals of Internal Medicine · doi:10.7326/m20-8079 · Cited by 64
Becerra, M. B., & Becerra, B. J. (2015) · Preventing Chronic Disease · doi:10.5888/pcd12.150006 · Cited by 47
Diabetes and cardiometabolic risk in South Asian youth: A review
Wolf, R. M., Nagpal, M., & Magge, S. N. (2020) · Pediatric Diabetes · doi:10.1111/pedi.13078 · Cited by 61
1. Strategies for Improving Care
American Diabetes Association (2015) · Diabetes Care · doi:10.2337/dc16-s004 · Cited by 117
“Recent studies have recommended lowering the BMI cut point for testing for Asian Americans to $23 kg/m(2) (44).”
BackgroundSocial, cultural and ethnic determinants of obesity: From pathogenesis to treatment
Capoccia, D., Milani, I., Colangeli, L., Parrotta, M. E., Leonetti, F., & Guglielmi, V. (2025) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2025.103901 · Cited by 60
Epidemiology of diabetes among South Asians in the United States: lessons from the MASALA study
Gujral, U. P., & Kanaya, A. M. (2020) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14530 · Cited by 57
Self-citationYi, S. S., Thorpe, L., Zanowiak, J., Trinh-Shevrin, C., & Islam, N. (2016) · American Journal of Hypertension · doi:10.1093/ajh/hpw014 · Cited by 44
Marcello, R. K., Dolle, J., Tariq, A., Kaur, S., Wong, L., Curcio, J., Thachil, R., Yi, S. S., & Islam, N. (2021) · Public health reports (1974) · doi:10.1177/00333549211061313 · Cited by 43
“Chinese patients were the oldest among Asian patients (median [IQR] age, 53 [38-64]) and among the oldest of all racial and ethnic groups.”
BackgroundImpact of risk factors for gestational diabetes (GDM) on pregnancy outcomes in women with GDM
Filardi, T., Tavaglione, F., Stasio, M. D., Fazio, V. M., Lenzi, A., & Morano, S. (2017) · Journal of Endocrinological Investigation · doi:10.1007/s40618-017-0791-y · Cited by 45
“The WHO and the ADA have recommended the use of lower body mass index (BMI) cut-off points for Asians (< 23 kg/m2 for normal weight) as the lower BMI cutoffs better identify health risks for T2D and cardiovascular disease among Asians [31, 32].”
InfluentialConroy, S., Shariff-Marco, S., Yang, J., Hertz, A., Cockburn, M., Shvetsov, Y. B., Clarke, C., Abright, C. L., Haiman, C., Marchand, L. L., et al. (2017) · Cancer Causes and Control · doi:10.1007/s10552-017-0980-1 · Cited by 44
Kalra, D. K., Vijayaraghavan, K., Sikand, G., Desai, N. R., Joshi, P. H., Mehta, A., Karmally, W., Vani, A. K., Sitafalwalla, S. J., Puri, R., et al. (2021) · Journal of clinical lipidology · doi:10.1016/j.jacl.2021.03.007 · Cited by 50
Tek, C. (2016) · Patient Preference and Adherence · doi:10.2147/ppa.s84778 · Cited by 38
“Also, for people of Asian ethnic origin, BMI cutoffs should be lowered by 2 or 3 points.(26,27) Furthermore, this writer is of the opinion that healthy overweight people with a BMI over 27 should be treated if their weight over the past few years has been consistently trending up.”
Metadata
- Authors
- Hsu, W. C., Araneta, M. R. G., Kanaya, A. M., Chiang, J. L., & Fujimoto, W.
- Affiliations
- Joslin Diabetes Center (US)
- University of California San Diego (US)
- University of California, San Francisco (US)
- American Diabetes Association (US)
- University of Washington (US)
- Corresponding author
- Hsu, William C.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-12-13
- Volume
- 38
- Issue
- 1
- Pages
- 150-158
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4392932
- OpenAlex
- W2138127318
- Cited by
- 500
- References
- 60
- Citations by year
- 2026: 23 · 2025: 20 · 2024: 36 · 2023: 40 · 2022: 50 · 2021: 62 · 2020: 48 · 2019: 52 · 2018: 45 · 2017: 52 · 2016: 37 · 2015: 33 · 2014: 1
- FWCI
- 6.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- Diabetes Action Research and Education Foundation
- World Health Organization
- Women's Health Initiative
- National Heart, Lung, and Blood Institute (K24HL112827, R01HL093009)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK063720)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- Asian Americans, type 2 diabetes, diabetes screening, body mass index, vulnerable populations, ethnic diversity, population growth
- MeSH terms
- Adult, Aged, Asian, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Obesity, Reference Values, Risk Factors, Body Mass Index, Prevalence, Overweight, Waist Circumference
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