The DOI matches its Crossref record; 41 of the 60 references it cites were found in a registry or an index.
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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A Systematic Mapping Study on the Risk Factors Leading to Type II Diabetes Mellitus
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The potential role of betatrophin in hepatocellular carcinoma and metabolic syndrome
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“After adjusting for age and gender, Asians are 30 to 50% more likely to develop type 2 diabetes at lower body mass index levels than non-Hispanic whites [7,12].”
BackgroundPrevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center
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“This is comparable to other studies where it was shown that pregnant women with pregestational diabetes were older and had higher BMI.(8,9)”
ResultStatus of Diabetes Care: New Challenges, New Concepts, New Measures—Focusing on the Future!
Cefalu, W. T., Boulton, A. J. M., Tamborlane, W. V., Moses, R. G., LeRoith, D., Greene, E. L., Hu, F. B., Bakris, G. L., Wylie‐Rosett, J., Rosenstock, J., et al. (2015) · Diabetes Care · doi:10.2337/dc15-0875 · Cited by 5
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“This observation parallels adult studies showing that Asian populations are more susceptible to glucose intolerance and T2DM at lower BMI levels [33] and have a higher prevalence of T2DM even at lower BMI thresholds [34].”
Cardiovascular Disease in South Asian Americans: A Serious Health Concern
Joseph, N. M., Strunk, F. A., Dhar, B., & Strong, L. (2023) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2023.104789 · Cited by 4
Abiri, B., Ahmadi, A. R., Mahdavi, M., Hosseinpanah, F., Amouzegar, A., & Valizadeh, M. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1134983 · Cited by 4
“Using a BMI ≥ 25 kg/m(2) as a threshold to define overweight/ obesity seems to be a more reasonable approach (19).”
BackgroundUsing Body Mass Index to Identify and Address Obesity in Asian Americans: One Size Does Not Fit All
Wee, C. C. (2022) · Annals of Internal Medicine · doi:10.7326/m22-2624 · Cited by 4
“The United States did not consistently track the prevalence of overweight and obesity in Asian Americans until the past decade (1).”
BackgroundInfluentialSakornyutthadej, N., Mahachoklertwattana, P., Chanprasertyothin, S., Pongratanakul, S., Khlairit, P., & Poomthavorn, P. (2021) · Pediatric Diabetes · doi:10.1111/pedi.13303 · Cited by 5
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“Abundant evidence pointed out that overweight and obesity are the risk factors of prediabetes [13,14].”
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“Previous studies have revealed the higher the body mass index (BMI, kg/m2) of an individual, the more likely they are to have metabolic disorders such as diabetes [4,5].”
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Sasaki, N., Maeda, R., Ozono, R., Nakano, Y., & Higashi, Y. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.108780 · Cited by 6
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Lifestyle for the prevention of type 2 diabetes: what is the role of genetic risk information?
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“Distinguishing between adiposity and other behavioral factors may be particularly important for studies of Asian populations who are at greater risk of T2D than Western populations at a given BMI (8).”
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Dietary Acculturation of Obesity Risk Reduction Behaviors in Chinese Americans
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“Finally, in East Asian populations, visceral adiposity at lower BMI, so called normal-weight obesity, is common and confers insulin resistance and adverse inflammatory profiles, offering a plausible substrate for the J-shape at low BMI 45,46 .”
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Comparison of Leptin and Tnf-Α Levels in Type 2 Diabetes Mellitus Patients with and Without Obesity
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“The American Diabetes Association recommends that all Asian Americans with BMI >23 kg/m 2 should be considered for diabetes testing [121].”
O’Brien, M. J., Zhang, Y., Bailey, S. C., Khan, S. S., Ackermann, R. T., Ali, M. K., Bowen, M. E., Benoit, S. R., Imperatore, G., Holliday, C. S., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1279348 · Cited by 3
“Asian adults exhibit a higher percentage of body fat at any BMI relative to White adults, as well as higher levels of visceral fat accumulation (28).”
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BackgroundBariatric surgery in patients with obstructive sleep apnea
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“9 kg/m(2) and uncontrolled diabetes mellitus type 2, metabolic syndrome, or Asian race (Tables 2, 3).(10,11) Importantly, OSA is considered a serious comorbidity.”
BackgroundInfluentialDifferential Cardiometabolic Risk Factor Clustering Across U.S. Asian Ethnic Groups.
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“This may explain why Asians appear to develop type 2 diabetes at a lower BMI than Whites [69].”
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“The result of high visfatin in ESRD group was in agreement with the results obtained by (2,11).”
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“Studies have also shown that AIs have a different body fat composition than other populations, with higher levels of visceral adipose tissue (Hsu et al. 2015; WHO Expert Consultation 2004).”
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“Asians have a high propensity for developing visceral fat, which is not reflected in the conventional BMI cut point for measuring body composition.(17) Therefore, a revised classification scale has been devised specifically for persons of Asian descent (Table 2).”
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Moore, B. F., Butler, L. M., Bachand, A. M., Salim, A., Reynolds, S. J., Wang, R., Nelson, T. L., Peel, J. L., Murphy, S. E., Koh, W., et al. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16245148 · Cited by 3
“These categories correspond to an elevated risk for chronic disease among Asian populations [26].”
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“Given that Koreans may be particularly insulin-sensitive and predisposed to dyslipidemia at lower BMI thresholds [37], even small dietary shifts toward high-fat, low-carbohydrate patterns may disproportionately elevate MetS risk.”
Peebles, E., Wang, Z., Dracup, E., Sarcione, C., Curry, C., Abrams, K., Onnela, J., Williams, M. A., Hauser, R., Coull, B., et al. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1585628 · Cited by 2
“Rather, the obesity cut off for Asian Americans should be 27 kg/m 2 as opposed to 30 kg/m 2 (36, 37).”
Spanuchart, I., Supachokchaiwattana, T., Thammavaranucupt, K., Pichitpichatkul, K., Worawichawong, S., & Bua-ngam, C. (2025) · JN. Journal of Nephrology (Milano. 1992) · doi:10.1007/s40620-025-02362-x · Cited by 2
“It is noteworthy that a significant portion of our patient population met the criteria for obesity based on BMI standards for Asians [10] and had relatively small kidneys with parenchymal thinning.”
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MethodSheikh, R., Jannat, T., Tamanna, S., Khan, N. I., & Islam, L. N. (2023) · Baghdad Journal of Biochemistry and Applied Biological Sciences · doi:10.47419/bjbabs.v4i04.272 · Cited by 2
“In recent years, Bangladesh has seen a rapid transition due to industrialization, climate change and urbanization towards sedentary lifestyle, and because of high intake of carbohydrate-rich diets, the prevalence of diabetes and OS may be on the rise among young people, which has not been adequately addressed.”
BackgroundInfluentialDavidson, J. C., Kent, B. V., Cozier, Y. C., Kanaya, A. M., Warner, E. T., Eliassen, A. H., Williams, D. R., & Shields, A. E. (2023) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-023-01765-5 · Cited by 2
“Asian populations have been noted to experience higher rates of obesity related health concerns (e.g., type-2 diabetes), than Western populations at any BMI [68, 69, 100, 101], supporting the use of a group-specific BMI cut point (27.5 kg/m 2 ) when investigating risk of disease.”
InfluentialSelf-citationHu, L., Wyatt, L., Mohsin, F. M., Lim, S., Zanowiak, J., Mammen, S., Hussain, S., Ali, S. H., Onakomaiya, D., Belli, H. M., et al. (2023) · JMIR Formative Research · doi:10.2196/52687 · Cited by 2
“…of diabetes for at least 12 months (for diabetes study participants); (5) have an HbA 1c of at least 7% in the last 12 months (for diabetes study participants); and (6) have a BMI of ≥ 23 kg/m 2 , as the threshold for overweight for Asian individuals [33] (for prediabetes study participants).”
BackgroundLow, Z., Liew, L. Q., Chua, V., Chew, S., & Ti, L. (2023) · BMC Surgery · doi:10.1186/s12893-023-02102-7 · Cited by 2
“A lower BMI cut-off value of 27.5 was used in this study in accordance with World Health Organization and American Diabetes Association [26, 27] recommendations for Asian patients, due to a genetic predisposition towards visceral adiposity, higher body fat percentage and increased cardiovascular complications for the…”
MethodInfluentialDifferences in diabetes risk factors among Asian Americans
Kwan, P., Watts, J. K., Prudencio, J. M., Chu, L., Co, D. E., & Chen, E. (2022) · Journal of public health · doi:10.1007/s10389-022-01779-z · Cited by 2
“Using body mass index cutoffs specifically adjusted for Asian Americans (Hsu et al. 2015; Suzuki et al. 2007), the average BMI for all Asian groups/categorization ranged from within healthy range (18.5–22.9) to above healthy range normal (23.0–26.9).”
InfluentialSleeve-Plus Procedures in Asia: Duodenojejunal Bypass and Proximal Jejunal Bypass
Lim-Loo, M. B. C., Huang, C.-K., Chan, V., & Chua, K. (2021) · Bariatric Surgery - From the Non-Surgical Approach to the Post-Surgery Individual Care · doi:10.5772/intechopen.96042 · Cited by 2
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“The relationship between body weight and the prevalence of type 2 diabetes is complex and appears to be modified by race/ethnicity.7 At similar BMIs, type 2 diabetes prevalence is higher in Asians compared with whites.7 This finding may be partly explained by differences in body fat distribution in that Asians have a…”
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Fitzpatrick, S., Rosales, A. G., Brown, S. D., Arterburn, D. E., Daley, M. F., Horberg, M., Koebnick, C., Oshiro, C., & Young, D. (2020) · Obesity Science & Practice · doi:10.1002/osp4.411 · Cited by 2
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“…their body fat distribution and relatively higher risk of having type 2 diabetes at Body Mass Index (BMI) levels lower than the cutoffs for obesity (Hsu et al., 2015) The databases of EBSCO HOST, GALE, GOOGLE SCHOLAR, SCIENCE DIRECT, SAGE, PROQUEST, SOCINDEX, and PUBMED were searched using the…”
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PLASMA MAGNESIUM STATUS IN TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT DIABETIC NEUROPATHY.
Khalil, F., ElAssal, P., Dabour, P. A. A., ElLatif, L. M., Khamiss, L. A., & abdEl-Hady., A. L. R. (2016) · doi:10.21474/ijar01/2037 · Cited by 2
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“Lower cut-off for BMI was also proposed for the Asians who have smaller body frames, are more insulin resistant, and have greater body fat for the same BMI than the Caucasians [35]-[37].”
BackgroundEpidemiology, Measurement, and Cost of Obesity
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Clinical Definition of Overweight and Obesity
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“The association between BMI and diabetes has been shown to vary by race and/or ethnicity [108, 110], but there is insufficient evidence to robustly estimate race and/or ethnicity-specific relative risk curves for each health outcome.”
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“2020) mengungkapkan bahwa persentase tertinggi, yaitu 65,39%, ditemukan pada insulin kerja cepat.”
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“Additionally, the risk of developing diabetes increases at a body mass index (BMI) of ≥25 kg/m 2 in Caucasians, whereas in Asians, this risk threshold is lower at a BMI of ≥23 kg/m 2 [11, 12].”
Cold and Hot Consumption and Health Outcomes Among U.S. Asian and White Populations
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“Asians are more prone to diabetes than Whites, even at similar or lower BMI levels (85,86) , partly due to higher visceral fat and lower muscle mass (87,88) , which may also reduce thermogenic capacity (89,90) .”
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“Utilizing BMI ≥ 25 kg/m 2 as a threshold to define over-weight/obesity appears to be a more reasonable approach [13].”
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“15,16 The metabolic profiles of the individuals were analyzed according to the criteria of Adult Treatment Panel III.”
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“다른 인종과 비교해 더 낮은 체질량지수에서 건강상의 문제가 발생하는 아시아인의 경우, 과체중은 ≥ 23 kg/m 2 , 비만은 ≥25 kg/m 2 를 적용할 것을 권장하기도 한다[6].”
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“…need for disaggregated data, several studies have reported differences in health behaviors and health outcomes according to Asian American ethnic group (Choi et al., 2013; Gordon et al., 2019; Hsu et al., 2015; Huang et al., 2013; Jih et al., 2014; Maxwell et al., 2012; Mui et al., 2017, 2018).”
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“19,20 In the Philippines, the Philippine Thyroid Diseases Study (PhilTiDeS 1) showed that thyroid dysfunction was more common among women, with a female to male ratio of 1.6:1.”
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“The literature has demonstrated Asian patients develop type 2 diabetes (DM2) at a younger age and lower body mass index (BMI) than non-Asian patients, and are more likely to suffer from complications of DM2, including increased mortality [2, 3].”
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Serum Chemerin Level as Biomarker for Renal Dysfunction in Type II Diabetes
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“(21) confirmed that type 2 diabetic patients predisposed to higher insulin resistance are more likely to develop microalbuminuria.”
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“), and/or the Indian subcontinent (Pakistan, India, Bangladesh, Nepal, Bhutan, and Sri Lanka) [2].”
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Leptin as a predictor of anthropometric cutoff points for obesity.
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“Furthermore, regional, ethnic and racial differences call for separate cutoff values individualized to each nation (Hsu et al., 2015).”
Background
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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