title: Ethnic admixture affects diabetes risk in native Hawaiians: the Multiethnic Cohort.
abstract: Obesity and diabetes rates are high in Native Hawaiians (NHs) who commonly have mixed ancestries. People of Asian ancestry experience a high risk of type 2 diabetes despite the relatively low body weight. We evaluated the impact of ethnic admixture on diabetes risk among NHs in the Multiethnic Cohort (MEC).
  
  
  
  On the basis of self-reports, 11 521 eligible men and women were categorized into NH/white, NH/other, NH alone, NH/Asian and the most common three ancestry admixture, NH/Chinese/white. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with the NH/white category as the reference group; covariates included known confounders-that is, body mass index (BMI), dietary and other lifestyle factors.
  
  
  
  The NH alone category had the highest proportion of overweight and obese individuals and the NH/Asian category the lowest proportion. During 12 years of follow-up after cohort entry at 56 years, 2072 incident cases were ascertained through questionnaires and health plan linkages. All NH categories had higher HRs than the NH/white category before and after adjustment for BMI. In the fully adjusted models, the NH/Asian category showed the highest risk (HR=1.45; 95% CI: 1.27-1.65), followed by NH/other (HR=1.20; 95% CI: 1.03-1.39), NH/Chinese/white (HR=1.19; 95% CI: 1.04-1.37) and NH alone (HR=1.19; 95% CI: 1.03-1.37). The elevated risk by Asian admixture was more pronounced in normal weight than overweight/obese individuals.
  
  
  
  These findings indicate that Asian admixture in NHs is associated with a higher risk for type 2 diabetes independent of known risk factors and suggest a role for ethnicity-related genetic factors in the development of this disease.
authors.affiliation: University of Hawaii Cancer Center, Honolulu, HI, USA.
authors.forename: G
authors.initials: G
authors.lastname: Maskarinec
authors.affiliation: University of Hawaii Cancer Center, Honolulu, HI, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Morimoto
authors.affiliation: German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Jacobs
authors.affiliation: Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA.
authors.forename: A
authors.initials: A
authors.lastname: Grandinetti
authors.affiliation: Department of Native Hawaiian Health, JABSOM, University of Hawaii, Honolulu, HI, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Mau
authors.affiliation: University of Hawaii Cancer Center, Honolulu, HI, USA.
authors.forename: L N
authors.initials: LN
authors.lastname: Kolonel
mesh_terms: D000368:Aged; D001213:Asian; D015992:Body Mass Index; D002681:China; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000235:genetics; D004032:Diet; D005260:Female; D020022:Genetic Predisposition to Disease; D006254:Hawaii; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander; D009765:Obesity / Q000208:ethnology; D050177:Overweight / Q000208:ethnology; D016016:Proportional Hazards Models; D012016:Reference Values; D012307:Risk Factors; D011795:Surveys and Questionnaires; D044465:White People