title: Standard definitions of overweight and central adiposity for determining diabetes risk in Japanese Americans.
abstract: BACKGROUND
  Despite having lower average body mass indexes (BMIs) than do whites, Asians are at high risk of type 2 diabetes, possibly because of their greater central adiposity. The criteria for identifying individuals at risk of obesity-related conditions are usually not population specific.
  
  
  OBJECTIVE
  Our goal was to determine whether the National Heart, Lung, and Blood Institute (NHLBI) overweight and obesity guidelines are useful for identifying diabetes risk in Japanese Americans.
  
  
  METHODS
  This was a prospective, cohort study of 466 nondiabetic Japanese Americans [age: 52.2 +/- 0.6 y; BMI (in kg/m(2)): 24.1 +/- 0.2; +/- SEM]. Diabetes status at a 5-y follow-up visit was assessed with an oral-glucose-tolerance test.
  
  
  RESULTS
  Among 240 subjects aged < or = 55 y, incident diabetes was strongly associated with overweight (BMI > or = 25) at baseline [relative risk (RR): 22.4; 95% CI: 2.7, 183; adjusted for age, sex, smoking, and family history] and weight gain of > 10 kg since the age of 20 y (adjusted RR: 4.5; 95% CI: 1.4, 14.5). NHLBI definitions of central obesity (waist circumference > or = 88 cm for women and > or = 102 cm for men) were unsuitable for this population because only 15 of 240 subjects met these criteria. A waist circumference greater than or equal to the third tertile was associated with diabetes (adjusted RR: 5.4; 95% CI: 1.7, 17.0). Among 226 subjects aged >55 y, incident diabetes was not associated with BMI, weight gain, or waist circumference.
  
  
  CONCLUSIONS
  NHLBI definitions are useful for identifying overweight Japanese Americans aged < 55 y who are at high risk of diabetes. Although central adiposity is an important risk factor, the guidelines for waist circumference are insensitive predictors of diabetes risk in this population.
authors.affiliation: Department of Medicine, the University of Washington School of Medicine, Seattle, WA 98195-6429, USA. mcneely@u.washington.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: McNeely
authors.forename: E J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: J B
authors.initials: JB
authors.lastname: Shofer
authors.forename: L
authors.initials: L
authors.lastname: Newell-Morris
authors.forename: D L
authors.initials: DL
authors.lastname: Leonetti
authors.forename: W Y
authors.initials: WY
authors.lastname: Fujimoto
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology*; D000886:Anthropometry; D001213:Asian; D001824:Body Constitution / Q000502:physiology*; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000208:ethnology; D011446:Prospective Studies; D012307:Risk Factors; D015430:Weight Gain