SAN DIEGO – .
Doug Brunk/MDedge News
Dr. Patrick Chen
“It appears that not all components of metabolic syndrome directly correlate with visceral fat,” lead study author Patrick Chen, DO, said at the annual Digestive Disease Week.
According to Dr. Chen, a gastroenterology fellow at Wright State University, Dayton, Ohio, the prevalence of obesity in the United States increased from 30.5% in 2000 to 39.6% in 2015, a condition that costs the U.S. medical system $150 billion each year and is associated with 19% of all deaths. “We also know that abdominal visceral fat is more associated with mortality and cardiac events than overall adiposity, while visceral fat contributes to nonalcoholic fatty liver disease and metabolic syndrome,” he said.
For Asian populations, the World Health Organization has set body mass indexes of 23 kg/m2 for overweight and 27.5 kg/m2 for obesity. “This has led to an ongoing debate as to whether we should be adopting regional anthropometric criteria based on race-unique risk factors,” Dr. Chen said. “Despite all of these association studies, the mechanisms are still undergoing research and still unknown to this day.”
For the current analysis, he and his colleagues assessed the prevalence of type 2 diabetes, hypertension, and hyperlipidemia and the impact of increasing BMI among racial groups in the United States. They drew from the National Ambulatory Medical Care Survey from 2011 to 2015 to collect and compare data on patient race, BMI, and the prevalence of type 2 diabetes, hypertension, and dyslipidemia, and used SPSS software for chi-square analysis. They excluded patients under the age of 18, those with type 1 diabetes, those with no listed race, and Native American populations, “since there were too few patients for meaningful analysis,” he said.
The 69,949 patients in the analysis included 57,448 whites, 9,281 African Americans, and 2,142 Asians. The majority (64,091) were listed as non-Hispanic, while 5,858 were listed as Hispanic. The mean age of the study population ranged from 49 to 55 years. African Americans had the highest mean BMI (31 kg/m2), followed by whites (29 kg/m2) and Asians (25 kg/m2). Meanwhile, both Hispanics and non-Hispanics had a mean BMI of 29 kg/m2.
Dr. Chen reported that African Americans (19.3%) and Asians (18.5%) had a higher prevalence of type 2 diabetes compared with whites (13.4%; P less than .001), while Hispanics had a higher prevalence of type 2 diabetes compared with non-Hispanics (18.9% vs. 13.9%; P less than .001). At the same time, African Americans had a higher prevalence of hypertension (49.6%) compared with whites (38.2%) and Asians (37.9%; P less than .001 for both associations), while non-Hispanics had a higher prevalence of hypertension compared with Hispanics (40.4% vs. 33.1%; P less than .001). Asians had a higher prevalence of hyperlipidemia (28.4%) compared with whites (25.6%; P = .004); both groups had a higher prevalence compared with African Americans (21.9%, P less than .001). Hispanics had a lower prevalence of hyperlipidemia compared with non-Hispanics (23.6% vs. 25.1%; P = .005).
“Diabetes, hypertension, and hyperlipidemia likely have different mechanisms that lead to different race’s predisposition to these diseases,” Dr. Chen concluded. “This study supports that regional anthropometric criteria should be done based on ethnicity-specific risk factors. Some food for thought is whether we need to change our screening guidelines for conditions like diabetes for Asian patients and hypertension in African American patients. We should also consider ethnicity when we look for NAFLD. Overall, continued research is needed to explain these correlations.”
The researchers reported having no financial disclosures.
SOURCE: Chen P et al. DDW 2019, Abstract 447.