BMI Cut Points to Identify At-Risk Asian Americans for Type 2 Diabetes Screening

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 fastest-growing 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 states—California, 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).Although it is clear that increased body weight is a risk factor for type 2 diabetes, the relationship between body weight and type 2 diabetes is more properly attributable to the quantity and distribution of body fat (3–5). Abdominal circumference and waist and hip measurements, although highly correlated with cardiometabolic risk (6,7), do not differentiate subcutaneous from visceral adipose abdominal depots and are subject to interobserver variability. Imaging and other approaches can be used to more accurately assess fat distribution and quantify adiposity (4,8), but they are not readily available, economical, or useable on …