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Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England : a population-based cohort study
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Caleyachetty, Rishi, Barber, Thomas M., Mohammed, Nuredin Ibrahim, Cappuccio, Francesco P., Hardy, Rebecca, Mathur, Rohini, Banerjee, Amitava and Gill, Paramjit (2021) Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England : a population-based cohort study. The Lancet Diabetes & Endocrinology, 9 (7). pp. 419-426. doi:10.1016/S2213-8587(21)00088-7 ISSN 2213-8587.
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Official URL: http://dx.doi.org/10.1016/S2213-8587(21)00088-7
Abstract
Background:
National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m2).
Methods:
In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15·0–50·0 kg/m2 and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data.
Findings:
1 472 819 people were included in our study, of whom 1 333 816 (90·6%) were White, 75 956 (5·2%) were south Asian, 49 349 (3·4%) were Black, 10 934 (0·7%) were Chinese, and 2764 (0·2%) were Arab. After a median follow-up of 6·5 years (IQR 3·2–11·2), 97 823 (6·6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m2 in White populations, the BMI cutoffs were 23·9 kg/m2 (95% CI 23·6–24·0) in south Asian populations, 28·1 kg/m2 (28·0–28·4) in Black populations, 26·9 kg/m2 (26·7–27·2) in Chinese populations, and 26·6 kg/m2 (26·5–27·0) in Arab populations.
Interpretation:
Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes.
Funding:
National Institute for Health Research.
Item Type: | Journal Article | ||||||||
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Subjects: | Q Science > QP Physiology R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Body mass index , Obesity, Non-insulin-dependent diabetes, Diabetics -- Minorities -- Services for --, Minorities -- Health and hygiene | ||||||||
Journal or Publication Title: | The Lancet Diabetes & Endocrinology | ||||||||
Publisher: | The Lancet Publishing Group | ||||||||
ISSN: | 2213-8587 | ||||||||
Official Date: | 1 July 2021 | ||||||||
Dates: |
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Volume: | 9 | ||||||||
Number: | 7 | ||||||||
Page Range: | pp. 419-426 | ||||||||
DOI: | 10.1016/S2213-8587(21)00088-7 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 18 May 2021 | ||||||||
Date of first compliant Open Access: | 19 May 2021 | ||||||||
RIOXX Funder/Project Grant: |
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