Waist measurement as an aid to type II diabetes screening among Asian Americans.

Abstract

Diabetes is a leading cause of death in the United States and is a significant health concern for Asian Americans. Here, Ema Ando and Mo-Kyung Sin from Seattle University College of Nursing make a case for waist measurement as an aid to screening for diabetes in Asian Americans.[Image omitted: See PDF.]Diabetes is the seventh leading cause of death in the United States.[1] It is estimated that about 29 million of the US population have diabetes.[1] Approximately 8.1 million of those with diabetes are undiagnosed.[1]Type II diabetes is a significant health issue among Asian Americans. A recent survey indicated that approximately 9.0% of Asian Americans have been diagnosed with diabetes.[1] According to the US Census Bureau,[2] Asian Americans are the fastest growing population in the United States with a 43% increase from 2000 to 2010. Understanding the difference in diabetes progression in this population is crucial for identifying those at risk.The national guidelines such as the American Diabetes Association (ADA)[3] and US Preventive Services Task Force (USPSTF)[4] currently recommend diabetes and pre-diabetes screening for those who are overweight and are at increased risk for diabetes. However, there are discrepancies in terms of body mass index (BMI) cut-off for overweight between the ADA and USPSTF. The ADA[1] and the World Health Organization (WHO)[5] recommend use of Asian BMI cut-off for overweight among Asians (BMI ≥ 23 kg/m2 ), while the USPSTF guideline is based on 25 kg/m2 for overweight. The Asian BMI cut-off could result in a greater proportion of Asian Americans being classified as overweight or obese. Researchers reported that Asian Americans have higher visceral adiposity even with normal BMI and are at greater risk of cardiometabolic disease with normal BMI.[6] Thus, it is likely that many pre-diabetic or diabetic Asian Americans may be missed.Like many other diseases, early stage of diabetes is asymptomatic. The triad of diabetic symptoms, such as polyuria, polydipsia, and polyphagia, is a sign of disease progression. Improvement of screening criteria to detect those currently undiagnosed at the earliest possible time is needed to improve health outcomes in high risk Asian Americans.Japanese Americans, for example, have a disproportionately high prevalence of diabetes while having lower BMI compared to Caucasians as well as to other Asian American subgroups.[7] According to the 2011-2012 California Health Interview Survey (CHIS), Japanese Americans were found to have the second highest prevalence of borderline diabetes (13.8%) after Filipinos and the second highest prevalence of diabetes (9.5%) after Koreans among Asian Americans.[8]Some have hypothesised that a 'westernised' lifestyle, a diet high in animal fat and a sedentary lifestyle, have caused the high prevalence of type II diabetes in the Japanese population.[9],[10] Studies acknowledge the relative significance of a diet high in meat and a sedentary lifestyle, even though these were greater risk factors for Caucasians.[11],[12] Another study found that a low fat diet and aerobic exercise decreased insulin resistance, but it did not alleviate the underlying beta-cell dysfunction and did not prevent glucose intolerance in the long term.[13]Increased body weight is a well-established risk factor for type II diabetes. Although BMI is the most widely used clinical tool to estimate body fat, it has its limitations in the estimation of body fat composition. Compared to Caucasians, Asian Americans have higher prevalence of diabetes but lower BMI.[7],[14] Researchers found that many Asian subgroups were more than 1.5 times more likely to develop type II diabetes than Caucasians.[14] This finding suggests that diabetes progression starts at a lower BMI in Asians relative to Caucasians. …